Falls: A marker of Preclinical Alzheimer’s Disease (Falls & AD)
Completed 2025
Funding: National Institute on Aging, 1 R01 AG057680-01A1
Brief Description
The purpose of this project was to examine relationships among falls, functional mobility and preclinical Alzheimer’s disease. We recruited 350 individuals who were enrolled in longitudinal studies at the Knight ADRC. We conducted one home visit annually for four years to administer a battery of assessments with items related to fall risk factors, including sensation, strength, balance, gait and home hazards. Participants completed monthly fall monitoring using a calendar-journal technique for the duration of the study.
Specific Aims
The first aim of this study was to examine the relationship between falls and functional mobility in the preclinical stages of Alzheimer’s disease.
The second aim of this study was to examine a hypothesized model of central and peripheral mechanism(s) underlying falls and functional mobility in preclinical stages of Alzheimer’s disease.
Key Publications
Keleman AA, Li M, Wisch JK, Bollinger RM, Krauss MJ, Grant EA, Benzinger TLS, Ances BM, Morris JC, Stark SL. Falls predict faster progression to Alzheimer’s dementia. Alzheimer’s & Dementia. 2026;22(2):e71177. doi: 10.1002/alz.71177
Washington SE, Bodde AE, Helsel BC, Bollinger RM, Smith N, Ptomey LT, Ances B, Stark SL. The association of dementia risk symptoms and functional activity in adults with Down syndrome. Alzheimer’s and Dementia Translational Research and Clinical Intervention. 2024;10(4):e70007. doi: 10.1002/trc2.70007
Keleman AA, Nicosia J, Bollinger RM, Wisch JK, Hassesnstab J, Morris JC, Ances BM, Balota DA, Stark SL. Precipitating mechanisms of falls in preclinical Alzheimer’s disease. Journal of Alzheimer’s Disease Reports. 2023;14(7):739-750. doi: 10.3233/ADR-230002
Keleman A, Wisch JK, Bollinger RM, Grant EA, Benzinger TL, Morris JC, Ances BM, Stark SL. Falls associate with neurodegenerative changes in ATN framework of Alzheimer’s disease. Journal of Alzheimer’s Disease. 2020;77(2):745-752. doi: 10.3233/JAD-200192
Building Capacity to Improve Community Participation for People Aging with Long-Term Disability Through Evidence-Based Strategies (DRRP)
Completed 2024
Funding: NIDILRR Rehabilitation Research Projects Community Living & Participation, 90DPCP0001-01-00
Brief Description
This project consisted of four distinct but interrelated research projects to promote participation for people aging with long-term physical disabilities:
- Develop a community-based research network—a formal network of researchers and community-based organizations serving older adults and people with disabilities—to serve as a platform and testbed for research studies.
- Conduct a longitudinal cohort study to examine changes in community participation in ~400 people aging with long-term physical disabilities over time, identifying potential intervention points to sustain participation.
- Culturally and pragmatically adapt an existing, effective evidence-based intervention (from gerontology and rehabilitation) and evaluate its efficacy for people aging with long-term physical disability in community settings.
- Conduct a pilot randomized controlled trial to examine the feasibility of implementing the adapted program through the community-based research network established under Project 1.
Specific Aims
To improve community participation for people aging with a long-term physical disability, our aims were to (1) establish a regional community-based research network (CBRN) consisting of researchers and community-based organizations (centers for independent living and area agencies on aging) that represent urban and rural communities, (2) conduct a longitudinal cohort study on the health and participation of people aging with long-term physical disability, and (3) build research capacity and facilitate the translation of evidence for community-based organizations.
In addition to the peer-reviewed publications below, this project generated a series of fact sheets and infographics.
Key Publications
Chen S-W, Krauss MJ, Somerville E, Holden B, Devine M, Stark S. Removing Environmental Barriers to Independent Living: A feasibility randomised controlled trial targeting people ageing with long-term physical disabilities. British Journal of Occupational Therapy. 2025;88(1):5-16. doi: 10.1177/03080226241280803
Dashner J, Espín-Tello SM, Chen S-W, Hollingsworth H, Bollinger R, Morgan KA, Stark S. Influence of falls, fall-related injuries, and fear of falling on social participation in people aging with long-term physical disability: A cross-sectional study. Disability and Rehabilitation. 2024;46(21):4979-4987. doi: 10.1080/09638288.2023.2293990
Putnam, M., Morgan, K., Hollingsworth, H., Heeb Desai, R., Chen, S.-W., & Stark, SL. Consistency of participation over time among persons aging with physical disability as measured by a tool designed for use among community-based organizations. Disability and Health Journal. 2024;17(1):101519. doi: 10.1016/j.dhjo.2023.101519
Morgan KA, Putnam M, Espín-Tello SM, Keglovits M, Campbell M, Yan Y, Wehmeier A, Stark S. Aging with long-term physical disability: Cohort analysis of survey sample in the U.S. F1000 Research. 2023; 14(11):68. doi: 10.12688/f1000research.74532.2
Minor BC, Dashner J, Espín-Tello SM, Bollinger R, Keglovits M, Stowe J, Campbell M, Stark SL. Development and implementation of a community-based research network. Journal of Clinical and Translational Science. 2020;4(6):508-514. doi: 10.1017/cts.2020.45
COMPASS, a Novel Transition Program to Reduce Disability After Stroke (COMPASS II)
Completed 2024
Funding: National Institute of Child Health and Human Development, 1R01HD092398
Brief Description
Community Participation Transition after Stroke (COMPASS) is an occupational therapy intervention to support individuals returning home from rehabilitation following a stroke. COMPASS uses two complementary evidence-based approaches: home modifications and strategy training delivered in the home. This study was a phase IIb, single-blind, parallel-group randomized controlled trial among patients undergoing inpatient rehabilitation for ischemic stroke. One hundred eighty-five participants were randomized to receive either COMPASS II or attentional control.
See the COMPASS intervention page for more information on the intervention.
Specific Aims
The aim of this study was to investigate the efficacy of COMPASS in reducing environmental barriers and improving daily activity performance, safety outcomes and community participation.
Key Publications
Bollinger RM, Krauss MJ, Somerville EK, Holden BM, Blenden G, Hollingsworth H, Keleman AA, Carter A, McBride TD, Barker AR, Yan Y, Stark SL. Rehabilitation transition program to improve community participation among stroke survivors: A randomized clinical trial. JAMA Network Open. 2024;7(10):e2437758. doi: 10.1001/jamanetworkopen.2024.37758
Krauss MJ, Holden BM, Somerville E, Blenden G, Bollinger RM, Barker AR, McBride TD, Hollingsworth H, Yan Y, Stark SL. Community Participation Transition After Stroke (COMPASS) randomized controlled trial: Effect on adverse health events. Archives of Physical Medicine and Rehabilitation. 2024;105(9):1623-1631. doi: 10.1016/j.apmr.2024.05.015
Feasibility of Community Participation Transition After Stroke (COMPASS)
Completed 2016
Funding: National Center for Medical Rehabilitation Research, 1R03HD079841
Brief Description
Community Participation Transition After Stroke (COMPASS) is a novel occupational therapy intervention designed to support persons with stroke as they transition from inpatient rehabilitation to home and community living. COMPASS uses two complementary evidence-based approaches: home modifications and strategy training delivered in the home. In this pilot study, we recruited 15 participants to test the feasibility of COMPASS and estimate the magnitude of the intervention’s efficacy.
See the COMPASS intervention page for more information on the intervention.
Specific Aims
The aims of this study were to (1) determine the acceptability and feasibility of COMPASS, testing intervention retention, fidelity, safety, and adherence, and (2) estimate the efficacy of COMPASS on the primary outcome of community participation, as well as exploratory outcomes of activity performance, quality of life, and community mobility to select optimal endpoints for a larger trial.
Key Publications
Stark S, Keglovits M, Somerville S, Hu Y-L, Conte J, Yan Y. Feasibility of a novel intervention to improve participation after stroke. British Journal of Occupational Therapy. 2017;81(2):116-124. doi: 10.1177/0308022617736704
Removing Home Hazards for Older Adults Living in Affordable Housing (HARP II)
Completed 2022
Funding: Department and Housing and Urban Development, MOHHU0040
Brief Description
The goal of this project was to conduct a hybrid effectiveness/implementation trial to simultaneously establish the effectiveness of the Home Hazard Removal Program (HARP) for fall prevention in affordable housing and to conduct a process evaluation of how the intervention works in the context of low-income senior apartments.
Specific Aims
The long-term goal of this study was to increase the supply of healthy housing in the U.S. in order to improve older adults’ ability to maintain their independence and safety. The specific aims of this study were to (1) determine the acceptability and feasibility of delivering HARP in low-income senior apartments and (2) determine whether the program was effective and cost-effective in reducing the rate of falls.
Key Publications
Krauss MJ, Somerville E, Bollinger RM, Chen S-W, Kehrer-Dunlap AL, Haxton M, Yan Y, Stark SL. Removing home hazards for older adults living in affordable housing: A stepped-wedge cluster-randomized trial. Journal of the American Geriatrics Society. 2024;72(3):670-681. doi: 10.1111/jgs.18706
Removing Home Hazards for Older Adults (HARP)
Completed 2018
Funding: Department of Housing and Urban Development, MOHHU0024
Brief Description
The Home Hazard Removal Program (HARP) is an intervention designed to reduce falls by removing hazards from the homes of older adults. We conducted a randomized controlled trial and implementation study of 300 older adults at risk for falls to test the program.
We recruited participants through St. Louis Area Agency on Aging’s annual assessment of participants’ health. Interventionists used a manualized protocol to deliver the intervention, and we followed participants monthly using a highly successful calendar-journal technique.
See the HARP intervention page for more information on the intervention.
Specific Aims
The first aim of the study was to determine the acceptability and feasibility of delivering the program in partnership with St. Louis Area Agency on Aging.
The second aim of this study was to examine the effectiveness of the program by conducting a hybrid effectiveness/implementation trial of 300 older adults at high risk for a fall. We tested whether HARP was effective in reducing the rate and risk of falls and improving other participant-reported outcomes that may be affected by the intervention.
Key Publications
Stark S, Keglovits M, Somerville E, Hu Y-L, Barker A, Sykora D, Yan Y. Home hazard removal to reduce falls among community-dwelling older adults: A randomized clinical trial. JAMA Network Open. 2021;4(8):e2122044. doi: 10.1001/jamanetworkopen.2021.22044
Retaining Participants in Longitudinal Studies of Alzheimer’s Disease (NACC)
Completed 2019
Funding: National Alzheimer’s Coordinating Center Collaborative Project, 2017-01
Brief Description
The purpose of this project was to study barriers and facilitators to retention of participants in longitudinal Alzheimer’s disease research and to develop guidelines for improving participant retention. We conducted a mixed methods study, employing identical procedures across three Alzheimer’s disease research centers (ADRCs): WashU (Knight ADRC), the University of Pittsburgh (Pitt-ADRC) and the University of Wisconsin (Wisconsin ADRC). We recruited community-dwelling older adults with decisional capacity and study partners to participate in the survey across the three centers. We also held focus groups with ADRC participants and study partners to elicit opinions about the guidelines.
Specific Aims
The specific aims of this study were to (1) identify participants’ perceived facilitators and barriers to remaining enrolled in longitudinal studies of Alzheimer’s disease, (2) identify study partners’ perceived facilitators and barriers to the participant remaining enrolled in longitudinal studies of Alzheimer’s disease, and (3) develop guidelines and examine the feasibility of implementing these guidelines to improve retention in longitudinal Alzheimer’s disease studies.
Key Publications
Bollinger RM, Gabel M, Coble D, Chen S-W, Keleman AA, Doralus J, Chin E, Lingler JH, Grill JD, Stark SL, Edwards DF. Retention of study partners in longitudinal studies of Alzheimer disease. Journal of Alzheimer’s Disease. 2023;94(1):189-199. doi: 10.3233/JAD-230079
Gabel M, Bollinger RM, Coble DW, Grill JD, Edwards DF, Lingler JH, Chin E, Stark SL. Retaining participants in longitudinal studies of Alzheimer’s disease. Journal of Alzheimer’s Disease. 2022;87(2):945-955. doi: 10.3233/JAD-215710
Gabel M, Bollinger RM, Knox M, Coble DW, Grill JD, Edwards DF, Stark SL, Lingler JH. Perceptions of research burden and retention among participants in ADRC cohorts. Alzheimer Disease and Associated Disorders. 2022;34(4):281-287. doi: 10.1097/wad.0000000000000514