OBJECTIVES:Older adults exhibit age-related declines in processes of attentional control, demonstrating an emergent need to identify mind-body interventions that support healthy cognitive aging. Mindfulness training is a promising intervention for improving attentional control processes, but relatively few methodologically rigorous studies have examined whether these effects extend to older adults. METHODS:This pre-registered Stage II randomized controlled trial (RCT) of older adults (N = 150), aged 65-85 years, examined the effects of eight weeks of Mindfulness-Based Stress Reduction (MBSR) versus an active control training program on immediate and long-term metrics of attentional control. RESULTS:Compared with the active control, MBSR did not differentially improve most metrics of sustained attention or mind-wandering, although a small effect was observed for self-reported task-unrelated thoughts. Improvements were observed in Go/No-Go (GNG) dL over time. Additionally, Groups differed on the GNG reaction time coefficient of variability and the Conners Continuous Performance Test d' and reaction time variability. DISCUSSION:Our findings suggest that mindfulness training compared to an active control may not differentially enhance attentional control among older adults.

Black family caregivers of older adults living with dementia are at high risk for negative impacts of caregiving, including poor overall health. Culturally responsive evidenced-based caregiving support interventions are lacking and may help to meet the unmet needs of Black family caregivers of people living with dementia. The purpose of this study was to test the feasibility and acceptability of the Peer Support for Family Caregivers of Black Older Adults Living with Dementia (Pair 2 Care) Intervention. Pair 2 Care is a 6-month, flexible, virtual peer support intervention co-designed with Black current family caregivers, former family caregivers (care recipient is deceased), community leaders, and healthcare providers. This intervention leverages the experiences of trained former caregivers as mentors to current caregiver mentees. A total of 15 current caregiver mentees were mentored by 11 trained former caregivers; all were female and mostly daughters who were caring or cared for a parent living with dementia. Pair 2 Care was found to be feasible and acceptable. All participants were enrolled, mentors were trained, and mentees and mentors were paired within 10 weeks. Former caregiver mentors were retained at 90% and mentees at 93%. Both mentors and mentees rated their overall Pair 2 Care experience as very high (9/10). Qualitative feedback was overwhelmingly positive, with several participants requesting to continue the program. Pair 2 Care may provide an innovative approach to improving family caregiver health outcomes. This award-winning intervention is poised to become part of existing innovations in aging that promotes health equity.

AIM(S):To explore the feasibility and acceptability of acoustic monitoring and real-time recommendations for stress detection and management (i.e., smarthealth intervention). DESIGN:This qualitative study used a framework of acceptability for healthcare interventions. METHODS:From January 2021 to December 2023 in the U.S.A., we interviewed 10 family caregivers who had completed the 4-month smarthealth intervention. The caregivers shared their user experiences and feedback on the system's feasibility and acceptability. Data were analysed using abductive thematic analysis, incorporating the framework of acceptability for healthcare interventions and the collected data. RESULTS:Seven themes and 19 categories emerged: attitudes, burden, ethicality, intervention adherence, intervention coherence, perceived effectiveness and suggestions. Feedback on the smarthealth intervention was mixed. Some found it beneficial, citing accuracy, ease of use and increased awareness. However, others felt burdened during its use, primarily due to time constraints. CONCLUSION:The smarthealth intervention can potentially improve caregivers' awareness of themselves and caregiving situations. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:Future directions should involve adapting the smarthealth intervention to consider diverse caregiving scenarios and incorporating a larger sample of caregivers. IMPACT:This is the first study to offer a voice detection system and real-time stress management recommendations to caregivers of people living with dementia. An individualised approach should be considered to improve the system's effectiveness. This includes providing personalised intervention components, considering caregivers' time and establishing a user-friendly system with high accessibility. The findings can be a cornerstone for smarthealth interventions influencing dementia caregivers' self-care and emotional regulation. REPORTING METHOD:Standards for Reporting Qualitative Research. PATIENT OR PUBLIC CONTRIBUTION:Members of the public and service users from a memory clinic and social media platforms contributed to the study by reviewing recruitment materials. TRIAL REGISTRATION:This trial's study protocol was registered with ClinicalTrials.gov (ID No. NCT04536701) on 3 September 2020 (https://classic. CLINICALTRIALS:gov/ct2/show/NCT04536701).

Social engagement is critical for caregivers, as isolation increases their risk for depressive symptoms and anxiety. Social engagement is not well-defined and is used interchangeably with other terms. We aim to define social engagement by examining its attributes, antecedents, consequences, and empirical referents in caregivers. Following Walker and Avant’s concept analysis, five databases—PubMed, CINAHL, PsycINFO, Scopus, and Web of Science—were utilized (with no year limit). The Stress Process Model was applied, and the Social-Ecological Model mapped the multilevel contextual influences on caregiver social engagement. Two authors independently screened the abstracts and full texts. Quality was assessed using the Joanna Briggs Institute tool. Twenty-seven studies define social engagement as actively interacting with others in safe, supportive environments where caregivers build meaningful relationships over time.” Four attributes were identified: engagement behaviors in social activities, shared and supportive contexts for interaction, meaningful relationships, and level of interaction. Four antecedent categories appeared at all socioecological levels, except for the macrosystem, and consequences were grouped into benefits and risks. None of the studies used a validated instrument or captured all four attributes. Five studies assessed activity types, nine captured shared contexts, two addressed meaningful relationships, two measured engagement levels, six measured contact frequency, and three measured network size. By providing a more precise conceptual definition of social engagement, this review lays the groundwork for future research endeavors. Moving forward, developing validated measures and exploring contextual variations in caregiver social engagement are critical.

Black females caring for family members living with Alzheimer’s disease and related dementias (ADRD) face high risks of caregiving stress and hypertension, leading to reduced quality of life and cardiovascular disease. While some interventions address ADRD caregivers’ stress and quality of life, gaps remain in targeting chronic caregiving stress and hypertension self-care. This Stage I (1R21AG077069) pilot study was conducted to determine the feasibility and acceptability of Mindfulness in Motion plus the Dietary Approaches to Stop Hypertension (MIM DASH) for Black female ADRD family caregivers. Participants (N = 28) were randomized to either MIM DASH or Alzheimer’s Association Caregiver Training (attention control) for eight weekly, 1.5-hour group sessions via Zoom Communications, Inc (video and telephone access). After completion of the intervention, both groups received eight weekly calls for two months, followed by one monthly call for four months. The intervention demonstrated high feasibility, with a 93% enrollment rate and 86% and 93% retention rates at three- and nine-month follow-ups, respectively. Participants in the MIM-DASH group attended an average of 6.29 sessions compared to 4.86 for the attention control group. Usability scores for MIM-DASH participants were high (mean 50.31), and satisfaction ratings averaged 8.77 out of 10. Credibility ratings were similarly robust, with a mean score of 41.23 out of 45 for the intervention group. Fidelity was maintained with minor deviations observed. MIM DASH was feasible and acceptable for Black female caregivers. Findings support the delivery of a Stage II efficacy trial.

Background: Researchers have encountered challenges in recruiting unpaid caregivers of people living with Alzheimer disease and related dementias for intervention studies. However, little is known about the reasons for nonparticipation in in-home smart health interventions in community-based settings. Objective: This study aimed to (1) assess recruitment rates in a smart health technology intervention for caregivers of people living with Alzheimer disease and related dementias and reasons for nonparticipation among them and (2) discuss lessons learned from recruitment challenges and strategies to improve recruitment. Methods: The smart health intervention was a 4-month, single-arm trial designed to evaluate an in-home, technology-based intervention that monitors stressful moments for caregiving dyads through acoustic signals and to provide the caregivers with real-time stress management strategies. The recruitment involved two main methods: on-site engagement by a recruiter from a memory clinic and social media advertising. Caregivers were screened for eligibility by phone between January 2021 and September 2023. The recruitment rates, reasons for nonparticipation, and participant demographics were analyzed using descriptive statistics. Results: Of 201 caregivers contacted, 11 were enrolled in this study. Eighty-two caregivers did not return the screening call, and others did not participate due to privacy concerns (n=30), lack of interest (n=29), and burdensome study procedures (n=26). Our recruitment strategies included addressing privacy concerns, visualizing collected data through a dashboard, boosting social media presence, increasing the recruitment budget, updating advertisements, and preparing and deploying additional study devices. Conclusions: This study highlighted barriers to participation in the smart health intervention. Despite several recruitment strategies, enrollment rates remained below expectations. These findings underscore the need for future research to explore alternative methods for increasing the recruitment of informal dementia caregivers in technology-based intervention studies. Trial Registration: ClinicalTrials.gov NCT04536701; https://clinicaltrials.gov/study/NCT04536701 International Registered Report Identifier (IRRID): RR2-10.1111/jan.14714

Purpose/Objectives We aim to explore Current Procedural Terminology (CPT) codes for caregiving training services and their potential impacts on caregivers of people living with dementia. Description of the Project/Program In response to the growing need for support for caregivers of people living with physical and mental health issues, CPT codes for caregiving training services will be activated for the calendar year 2024. These codes cover (1) family group behavior management and modification training services and (2) caregiver training for techniques to help patients maintain their quality of life. Caregivers will access such training support through the CPT codes provided by treating practitioners. The duration of training will vary by code. Outcome Implementing CPT codes for caregiver training services highlights the vital role of caregivers in patient care. This support may improve their skills and communication with healthcare providers. However, timing and accessibility in care delivery need clarification, especially for caregivers of people living with dementia. Regular skill assessment and culturally competent care are essential. Before providing the service, provider training may also promote person-centered care, benefiting patients and their caregivers. Conclusion Activating CPT codes for caregiving training services may enhance caregivers' support and skills, including dementia care.

Background Millions of people live with dementia worldwide, relying heavily on family caregivers. Pain is common in both people living with Alzheimer's disease (PLWAD) and their caregivers, contributing to stress and burden. To our knowledge, this is the first study to examine the relationship between pain, stress, hair cortisol, and mental health in PLWAD and their caregivers and how these factors are linked to caregiver burden. Methods This exploratory pilot study included five PLWAD-caregiver dyads. Participants completed questionnaires on pain, mental health, and demographics. Hair samples were collected for cortisol analysis. Pearson correlation coefficients (r) were used to assess relationships between various factors of PLWAD and their caregivers. Results Contrary to expectations, pain and mental health measures for PLWAD displayed a trend toward negative correlation with their hair cortisol levels. Conversely, caregiver pain and mental health measures had a trend toward positive correlation with their hair cortisol levels. There was also a trend that higher pain in PLWAD was associated with higher caregiver burden. Conclusion This exploratory pilot study showed associational trends suggesting a complex relationship between pain, mental health, and stress in PLWAD-caregiver dyads. This preliminary work will inform future studies that can help advance targeted, tailored interventions.

Caregivers of persons living with Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) tend to neglect their health, including by ignoring their stress levels. African American women are particularly vulnerable to this, and they are also particularly susceptible to hypertension. Addressing stress reactivity/stress resilience is vital in lessening their stress related to caregiving, enhancing their quality of life, and fostering healthy blood pressure self-care behaviors This pilot study aims to investigate the feasibility and acceptability of implementing the Mindfulness in Motion (MIM) plus the Dietary Approaches to Stop Hypertension intervention (MIM DASH) in this population and to evaluate its effect on AD/ADRD caregivers’ stress and quality of life. Additionally, the study explores the mediating role of stress reactivity/stress resilience between interventions and self-care behaviors. A small RCT pilot study will recruit 28 African American/Black female caregivers aged 40 years or older living with hypertension. Participants will be randomly assigned to either the MIM DASH intervention or the Alzheimer’s Association Caregiver Training group (attention control). Both interventions will be delivered over eight weeks through one-hour group telehealth sessions, accessible via video or telephone. After completing the health intervention, both groups will receive coaching calls over nine months, beginning with eight weekly calls followed by four monthly calls to encourage participants to utilize the educational materials. This study is an ongoing project. Recruitment, intervention delivery, and fidelity monitoring have been completed. Final data collection and analysis will occur by December 2024. Our research will be pioneering in elucidating the mechanisms underlying stress reactivity/stress resilience, exploring African American female caregivers' psychological and physiological responses to stress, and investigating their self-care behaviors. These insights will pave the way for a larger randomized controlled trial to evaluate the effects of MIM DASH among African American female caregivers of persons living with dementia. NCT05721482

Abstract Dementia care can cause emotional distress among caregivers. As technology advances, innovative interventions to alleviate stress in this group have emerged, highlighting the need for more investigation. We aimed to develop a deep learning-based smarthealth intervention using acoustic monitoring and ecological momentary assessment to detect stress and deliver stress management messages. We also intended to identify the intervention effects on the reactions and emotions of caregivers of people living with dementia. During the four-month intervention period, we collected data about participants’ emotional status and reactions to their care recipients’ symptoms through pre- and post-questionnaires, periodic phone surveys, and semi-structured interviews. Descriptive analysis, Wilcoxon signed-rank test, and abductive thematic analysis were used. Ten of 11 participants completed the study. The average age was 60 years, and participants reported providing care for approximately three years. Participants were predominently female (72.3%), White (81.8%), and spouses (63.6%). Pre-and post-questionnaires showed significant changes in caregivers’ perceived frequency of care recipients’ disruptive symptoms (p=.026) and their reactions to these symptoms (p=.006), but not in other emotional-related variables. Although answers to periodic phone surveys varied, participants tended to consider self-care when they reported better physical health and less stress and depressive mood. Interviews revealed seven themes—affective attitudes, burden, ethicality, intervention adherence, intervention coherence, perceived effectiveness, and suggestions—containing 27 categories. While participants’ feedback on our smarthealth intervention was mixed, the intervention improved participants’ awareness of emotions and caregiving situations. The findings suggest the potential benefits of the smarthealth intervention on caregivers’ awareness of emotions and self-care.

Black, Indigenous, and other people of color are at greater risk of developing Alzheimer’s disease and related dementias (ADRD). These individuals are less likely than non-Hispanic whites to have access to ADRD- related resources, thus promoting health disparities. In 2022, the Alliance for Diversity in Brain Health for the Central Ohio Community (ADHOC) was created to fill this gap. Through grass roots efforts from the College of Nursing, the African American Alzheimer’s and Wellness Association teamed up with the Central Ohio Alzheimer’s Association. With leadership support from the National Alzheimer’s Association, we identified strengths, opportunities for collaboration, and long and short-term goals to meet the needs of the Central Ohio ADRD community. Monthly meetings were held with a core group of four members to establish a community-driven agenda for education, support, and research. To date, ADHOC results included a) grant-funded, inaugural Annual Brain Health Fair with 14 local partnering agencies, b) five ADRD education presentations in five minoritized communities, and c) six research collaborations. Our alliance provides a template that can scaled for use in communities globally to build bridges and promote health equity in ADRD communities through education, support and research.

BACKGROUND:The prevalence of hypertension is 55% among African American/Black women, who have a higher risk for poor health outcomes compared to women from other racial and ethnic groups, in part because of uncontrolled blood pressure. Previous research results suggest that peers may positively influence self-management of chronic conditions like hypertension. However, few studies have described the personal characteristics of peers in the health social networks of Black women.OBJECTIVE:This substudy aimed to examine health social networks and describe the peers' characteristics, as reported by a convenience sample of Black women with hypertension.METHODS:In this analysis of data from a larger study, 94 Black women with hypertension attending a church conference participated in a cross-sectional, descriptive study. Their mean age was 59 years, and their mean systolic blood pressure was 143 mm Hg. All participants completed a survey to gather data about (a) the characteristics of individuals they discussed health matters with (their peers or health social network) and (b) their perceptions about hypertension status and knowledge of hypertension among the peers in their health social network.RESULTS:Collectively, participants from the larger study named a total of 658 peers who were part of their health social networks; the mean health social network size was six peers. The peers were mostly women, Black, family members, and, on average, 54 years old. The participants discussed hypertension with 71% of the peers, reported that 36% had hypertension, and felt that 67% were somewhat or very knowledgeable about the condition. A small, positive correlation existed between the participants' health social network size (number of peers named) and their systolic blood pressure levels.DISCUSSION:The health social network peers were similar to those in the larger study, with most of the same gender, race, and age. The findings of this analysis may be used to help practitioners and scientists guide patients in building health social networks for support in self-managing hypertension and conducting future studies to examine the best strategies for developing and using health social networks to improve health outcomes and reduce health disparities.