PROJECT SUMMARY/ABSTACT This project builds on the Preferences for Everyday Living Inventory (PELI), a comprehensive measure of preferences for everyday living developed from data from over 500 randomly selected cognitively intact elderly home care recipients. Recent conceptualizations of optimal care in the nursing home (NH) emphasize the need to "know the person" as a prerequisite for delivering individualized, holistic care that addresses the elder's medical, psychological, social and spiritual needs. However, non-medical preferences (e.g. type and amount of social contact, leisure and growth activities, amount of control and independence desired, characteristics of caregivers, and daily routines) are not assessed systematically or comprehensively. Several studies have documented the importance of integrating personal preferences for everyday living on satisfaction and the quality of daily life of frail seniors. The PELI will be adapted for use with Veterans in the community living center (CLC), a nursing home setting serving those with a wide range of disabilities, in order to individualize treatment. The ability to assess the full range of personal preferences systematically from the perspective of CLC Veterans is the first step to designing appropriate interventions. Two measurement issues are central to advancing this line of scientific inquiry and will be addressed in this project. First, current methods of assessing preferences for everyday living are narrow in scope. While these assessments move clinicians closer to the ultimate goal of providing individualized care (IC), they miss the broader assessment issues of (i) capturing the holistic aspect of older Veteran's preferences, and (ii) tailoring care to reflect the preferences that are most important to the individuals themselves. The current study seeks to address this gap with three aims, Aim 1) by examining the content and meaning of preference items with Veteran residents in the CLC through cognitive interviewing, Aim 2) by adapting the PELI to be able to systematically obtain CLC Veterans' perspectives on what preference domains and items are most important to them, and Aim 3) test the feasibility of using the PELI with CLC Veterans with mild to moderate cognitive impairment in order to identify most and least significant areas of preferences from their perspective. Second, a central concern in providing IC delivery is how to accommodate changes in a Veteran's psychosocial preferences over time. Aim 4) of this study will address the question of test-retest reliability of an individual's stated preferences over one week and examine the impact of cognitive functioning on reliability. The final Aim 5) is to prepare multisite HSRD application focused on stability of Veteran preferences as assessed by the PELI over longer time periods, subjective and objective assessment of preference fulfillment as a quality improvement indicator, and intervention studies around integrating preferences into care planning and addressing the cause of behavioral disturbances in Veterans in the CLC. We propose to use a mixed method design of both qualitative data from cognitive interviewing and repeated measures design using quantitative methods to revise the PELI. This data will assist in creating a preference assessment tool based on the perspective of the CLC Veteran, determine feasibility for use with Veterans in the CLC, and to address the issue of the reliability of these preferences over time. Those persons who are > 55 years old, without severe cognitive impairment - defined as > 2nd percentile on the Modified Mini Mental Status Exam (3MS) - will be included in the study. Pilot data will enable the submission of a larger multisite HSR&D intervention study around integrating holistic preferences into care planning and using preference fulfillment as a quality improvement indicator.

PROJECT NARRATIVE The primary goal of this study is to redesign and assess the test-retest reliability of a measure of psychosocial preferences for everyday living in a frail Veteran community living center resident population. Several studies have documented the importance of integrating personal preferences in care on satisfaction and quality of life of frail seniors. Development of a comprehensive, reliable and standardized assessment of personal preferences is a necessary first step for an intervention study to integrate preferences into care planning in order to enhance holistic individualized care to Veterans in the community living center.