Laura N. Gitlin

Background: Nonpharmacological strategies are first‐line treatments for behavioral symptoms, the most distressful aspect of dementia care. Few caregivers have knowledge of or access to effective strategies. We tested the effects of WeCareAdvisor, a web app to help caregivers problem‐solve and identify nonpharmacological strategies to manage behaviors. Participants/Setting: Two hundred and sixty‐two community‐living caregivers of people with dementia. Methods: Prospective two‐group randomized trial comparing immediate app users ( N = 131) to 3‐month delayed app users (controls, N = 131). Interviewers masked to participant allocation conducted baseline, 1‐(check‐in), and 3‐month (main endpoint) interviews. Using the DICE approach, immediate users answered brief questions to describe targeted behaviors and investigate contributors from which the app creates “Prescriptions” detailing strategies that caregivers evaluate if effective. Educational materials were also available. Three primary outcomes (caregiver distress, confidence managing behaviors, behavioral frequency by severity) and seven pre‐specified secondary (number, frequency, severity of behaviors, functional dependence and caregiver‐associated upset, wellbeing, and communications) outcomes were examined. Results: Caregivers were 63.8 (SD = 10.6) years old, mostly female (82%), spouses (65%), with some college (93%); 83% were White, 10% Black, 3% Asian, or other/multi‐racial group (3.9%). Most (87%) lived with people with dementia who averaged 75.1 (SD = 10.5) years, were primarily male (57%) and White (82%), with moderate–severe dementia (62%) and averaged 6.4 (SD = 2.8) behaviors. There were no treatment differences between groups in behavioral symptoms, or caregiver distress and confidence at 3 months. However, the difference in caregiver distress between immediate versus delayed user groups was apparent over time by 3 months (Bonferroni corrected p for interaction between time and intervention = 0.012). In secondary analyses, by 3 months, immediate users versus controls, reported fewer behaviors ( p = 0.02), less functional dependence ( p = 0.05) and associated caregiver upset ( p = 0.005), and improved caregiver wellbeing ( p < 0.001). Conclusions: WeCareAdvisor use was associated with significant and clinically meaningful improvements in caregiver distress and wellbeing, although differences in frequency/severity of behaviors were not significant. Trial Registration: NCT05012410; https://clinicaltrials.gov/study/NCT05012410 . Initial registration date: 08/12/2021

Family care partners for persons living with dementia (PLwD) adopt a variety of care management strategies to navigate care. We utilize a convergent parallel mixed-methods design to integrate family care partners’ descriptions of care challenges and associated management approaches. Primary family care partners for PLwD (n = 100) were interviewed about their management of a care challenge (qualitative), the PLwD’s function, behavior and cognition (quantitative), and their management strategies (qualitative/quantitative). Care challenges and strategies were compared across qualitative content analysis and t-tests. Care partners providing more functional (r = 0.34, p < 0.01) and cognitive (r = 0.30, p < 0.01) care used more active management strategies, whereas care partners providing greater behavioral care (r = 0.34, p < 0.001) reported more criticism, with similar themes seen qualitatively. Active management may be required when dementia severity increases, yet criticism may emerge with greater behavioral severity. Because criticism is associated with more negative outcomes, future interventions should help care partners practice more adaptive behavioral management.

Background and Objectives: There is a need to understand Black older adults’ perceptions and attitudes about commercial activity trackers to measure and monitor outcomes in clinical trials. We sought to identify the preferred activity tracker features of Black older adults living with memory challenges or dementia and their care partners. Methods: Utilizing a mixed-methods convergent parallel design, 9 participants were recruited from Eskenazi Health in Indianapolis, Indiana. Data were collected through 2 focus groups with participants (n = 3) and care partners (n = 4), and a group interview with 1 participant and 2 care partners. The focus groups were guided by semi-structured interviews, whereas participants interacted with 4 common consumer activity tracking devices (Fitbit Inspire 3, Apple Watch SE, Polar Watch, Oura Ring Heritage). Audio recordings were analyzed using the Rapid Identification of Themes from Audio Recordings method. Participants ranked each device based on comfort, convenience, and features (eg, tracked outcomes of activity, distance/GPS, and respiratory rate). Device rankings were summarized with descriptive statistics. Results: Participants with memory challenges rated Apple Watch SE highest, with mean scores in comfort (4.3), convenience (3.3), and features (4.3). Care partners rated Fitbit Inspire 3 highest in comfort and Apple Watch SE for convenience and features. Qualitative findings highlighted physical attributes and comfort (large screen size), convenience (viewing progress), and features (having an emergency button and GPS). Discussion and Implications: Findings can guide the selection of activity trackers in future research for this population and may increase wear time and adherence in clinical trials.

Objectives: Loneliness and social isolation are associated with significant negative impacts on physical and mental health. Living alone increases one’s risk for loneliness and social isolation. Many older adults live alone, including individuals with mild cognitive impairment (MCI) and subjective memory decline. Living alone with a diagnosis of MCI or subjective memory decline adds greater complexity, stress, and difficulty in navigating daily life due to loneliness, social isolation, and negative mental and physical health outcomes. Despite these concerns, there is a dearth of support interventions for older adults who live alone with memory decline. Home Alone is a new support program created for this unique population of older adults in continuing to live independently and safely while engaging in social and meaningful activities. This pilot study evaluated the feasibility of the novel Home Alone support program. Methods: Home Alone is a seven‐session psychosocial and psychoeducational intervention that provides one‐on‐one, tailored coaching in person or via telehealth. Home Alone focuses on promoting home safety strategies and modifications and encouraging personally meaningful activity and social engagement through behavioral activation‐based tasks. Fifteen older adults who live alone and have MCI or subjective memory decline enrolled in the 3‐month feasibility study to evaluate the initial program and inform its refinement. Mixed methods data were collected from 1‐ and 3‐month follow‐up surveys. Additional qualitative data on participants’ experiences of the Home Alone intervention were collected at post‐intervention interviews. Results: Results demonstrated preliminary feasibility, utility, and acceptance of Home Alone. Qualitative analyses of participant interviews identified useful aspects of the intervention, including home safety, meaningful activity, and socialization, as well as recommendations for program refinement. Discussion: The Home Alone program was well‐received and viewed as valuable by participants. Participant feedback and recommendations were incorporated to further improve the intervention. The refined Home Alone intervention is now being evaluated in a larger pilot trial. Trial Registration: ClinicalTrials.gov identifier: NCT05746390

To determine the net cost of non-drug interventions that maintain or improve a person with dementia’s physical function and/or reduce challenging beh

INTRODUCTION: Older adults with cognitive impairment (CI) face challenges to aging in the community. Little is known about the housing characteristics of US older adults with CI. METHODS: Using the 2022 National Health and Aging Trends Study, we describe housing characteristics of community‐living older adults ≥ 65 years with CI ( n = 968) using descriptive statistics (frequencies) and conduct chi‐squared tests to compare characteristics of those who lived with others ( n = 707) versus alone ( n = 261). RESULTS: Renting (41%), home modifications (59% had ≥ 2), and interior home disorder (45%) were prevalent among older adults with CI. Those living alone more commonly rented, lived in an apartment or mobile home (vs. house), and had more home modifications than those living with others (all p < 0.05). DISCUSSION: Further study should examine how housing characteristics support or deter daily function and inform the long‐term services and supports needed by this high‐needs, understudied population. Highlights: There are 5.5 million older adults living in the community with cognitive impairment (CI). Of this population, 26% live alone. Older adults living alone with CI are primarily female, older, with lower incomes. Nearly half of older adults living alone with CI are renters. Home accessibility modifications were very common in this population.