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.

OBJECTIVES:Family caregivers of people with dementia typically do not receive strategies or education to manage daily care challenges. The CareWell program addressed this gap by pairing coaches with a digital platform (web app) Plans4Care's On-Demand Dementia Toolkit for Professionals that generates evidence-based personalized action plans to address care challenges. DESIGN:This is a program evaluation of the real-world implementation of CareWell with 26 caregivers to understand feasibility and direction of outcomes. SETTINGS AND PARTICIPANTS:From January 2025 to April 2025, caregivers of persons with dementia were recruited nationally online as part of normal operating procedures for a 5-session coaching program designed to provide support and strategies for managing dementia-related care challenges. METHODS:Guided by a Plan-Do-Study-Act framework, we evaluated the feasibility of having caregivers complete pre- and postprogram assessments of their perceived program benefits. Measured was caregiver stress, well-being, quality of life, and program satisfaction and caregiver ratings of quality of life for the person with dementia. RESULTS:Sixteen (62%) of 26 caregivers completed pre and post surveys. Caregivers reported decreased stress and improved well-being and quality of life for themselves and perceived that the person living with dementia had improved quality of life. Satisfaction with the program was high, with an average score of 4.7 of 5. CONCLUSIONS AND IMPLICATIONS:Pairing coaches with a digital platform that generates evidence-based solutions to common dementia-related challenges is a feasible and valuable approach for improving family well-being. Use of a web application offers a scalable approach for upskilling the dementia-capable workforce and family caregivers.

The Tailored Activity Program (TAP) effectively manages Behavioral and Psychological Symptoms of Dementia (BPSD), yet its feasibility across the hospital-to-home care continuum for people living with dementia (PLwD) has not been tested. To assess the feasibility of TAP-Continu-A-Mente intervention for managing BPSD in PLwD transitioning from hospital to home, either following a short-stay observation or a memory clinic evaluation. Secondary aims were to evaluate changes in PLwD BPSD, caregiver distress and sense of competence, healthcare use, dyad satisfaction. This single-arm interventional feasibility study enrolled 50 dyads (PLwD and caregivers) at IRCCS San Gerardo Hospital (Monza, Italy). PLwD inclusion criteria were age ≥65, dementia diagnosis, Neuropsychiatric Inventory (NPI) ≥6 in at least one item, independence in at least two basic activities of daily living, fluency in Italian. The intervention consisted of eight sessions over three months (two in hospital and six at home) delivered by occupational therapists. The primary outcome was the proportion of dyads completing the program (dyad retention). Secondary outcomes, assessed at baseline and four months, included NPI, Clinical Frailty Scale (CFS), motor-functional status (Katz Index, TUG), caregiver self-efficacy (SCQ), and dyad satisfaction. PLwD had a median age of 81 (Q1–Q3: 77–86), and 52

Objective:This study evaluates the equivalency (noninferiority) of two approaches to training clinicians in the delivery of an evidence-based dementia caregiving program in PACE (Programs of All-Inclusive Care of the Elderly) settings. Considered are clinician outcomes following each training method and PACE participant-caregiver outcomes following COPE receipt after 4 months. Design:11 PACE settings were randomized to have clinicians trained in-person (n = 7) or online (n = 4) to deliver COPE to caregivers of patients with dementia. Setting:PACE provides long-term care services and support to dually eligible older adults (PACE participants), most of whom have dementia diagnoses, to age in place at home. Participants:The study included occupational therapists (n = 14) and registered nurses (n = 8) employed at participating PACE sites. Caregivers (n = 17) and PACE participants (n = 17) with dementia were enrolled as dyads to receive COPE. Measurements:Primary outcomes included changes in clinician knowledge and training satisfaction via the Knowledge and Skills Survey and implementation competence via the Normalization Process Theory (NoMad) survey. For dyad outcomes, caregivers identified priority areas using validated assessments, selected up to four "target behaviors" and rated confidence in managing each. Results:No significant differences were found between training groups in clinician or dyad characteristics. Training modalities showed similar impacts on clinician knowledge and skills, with no statistically significant differences between groups in change scores across NoMad domains (all p >0.3). After COPE, all caregivers reported significant improvement in the Perceived Change Index (p = 0.0034) and increased confidence in managing target behaviors. Conclusion:Online training in COPE was noninferior to in-person training for clinician competence and PACE participant-caregiver outcomes. These findings support online training as a scalable approach for disseminating evidence-based dementia care programs without compromising effectiveness.

OBJECTIVE:To determine if home environmental features (ie, lighting and home hazards) are associated with difficulties in instrumental activities of daily living (IADLs) in persons with glaucoma. DESIGN:Cross-sectional study. SETTINGS AND PARTICIPANTS:A total of 174 adults with suspect or primary glaucoma were recruited. METHODS:IADLs, fear of falling (FoF), and glaucoma quality of life (GQL) were assessed via questionnaire. FoF and GQL were prespecified as negative controls to assess discriminant/external validity, as they are not expected to be influenced specifically by in-home lighting or hazards. We classified IADL difficulty as a binary outcome (≥1 IADL difficulty vs none). Person-measure scores for FoF and GQL were calculated in logits using Rasch modeling. The home environment assessment for the visually impaired (HEAVI) tool assessed homes for the total number of hazards, frequency of hazards among graded items, and average home lighting. Multivariable logistic and linear regression models evaluated associations between home environmental measures with IADL difficulty and FoF and GQL scores, controlling for severity of visual field damage, age, race, sex, comorbidity, and polypharmacy. MAIN OUTCOME MEASURES:Association between home environmental features with difficulties in IADLs, FoF, and GQL. RESULTS:Better home lighting was associated with less difficulty completing IADL tasks (odds ratio [OR] = 0.88 per 0.1 log unit light increment, 95% CI = 0.77-1.00, P = .04). No association was found between the number of home hazards (OR = 0.97 per 10 additional hazard, 95% CI = 0.62-1.53, P = .89) or the frequency of home hazards among graded items (OR = 1.10 per 10% increment in hazard frequency, 95% CI = 0.65 to 1.86, P = .73) with IADL difficulty. No significant associations were noted between lighting levels, frequency or number of home hazards with FoF or GQL scores. CONCLUSION:Better home lighting was associated with less frequent difficulty with IADLs (but not FoF or GQL) in a cohort enriched for glaucoma; no associations were noted with any measure for home hazards. Lighting may be able to improve specific aspects of function in persons with glaucoma.

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.