Adapting Connect-Home Transitional Care to Fit the Unique Needs of Persons with Alzheimer's Disease and Other Dementias and their Caregivers: A Pilot Study

NIH RePORTER · NIH · R01 · $381,684 · view on reporter.nih.gov ↗

Abstract

PROJECT SUMMARY/ABSTRACT Persons with Alzheimer’s disease and related dementias (AD/ADRD), who receive care in skilled nursing facilities (SNF), are a medically complex population with substantial dependence on family caregivers. Despite the high prevalence of acute care use and mortality after persons with AD/ADRD return home, no studies designed or tested transitional care to prepare persons with AD/ADRD and their caregivers for transitions from SNFs to home. In the parent study (Connect-Home Clinical Trial [R01NR017636]), we are conducting the first efficacy trial of transitional care for seriously ill persons receiving SNF care and their caregivers. The objectives in this supplement are: (1) to adapt Connect-Home for the unique transitional care needs of persons with AD/ADRD and their caregivers and (2) to study the feasibility, acceptability, and outcomes of the adapted intervention. Our central hypothesis is that by applying a systematic, stakeholder-engaged approach, we will adapt Connect-Home to support the delivery of transitional care to meet the distinct care needs of persons with AD/ADRD and their caregivers. The rationale for this study is that adapting and testing Connect-Home will generate a new model of transitional care for a future efficacy trial. We propose two specific aims: (1) engage diverse stakeholders to identify unmet needs or persons with AD/ADRD and their caregivers and co-produce an adapted version of the Connect-Home intervention for persons with AD/ADRD and their caregivers; and (2) determine the feasibility and acceptability of the adapted intervention and estimated mean outcomes of persons with AD/ADRD and their caregivers. The setting for the study will be four SNFs that currently use the Connect- Home intervention. The sample will include (1) persons with AD/ADRD, (2) caregivers (e.g., family members) of persons with AD/ADRD, and (3) SNF and home care staff. In Aim 1, we will engage a steering committee (comprised of academic, SNF/home care and caregiver stakeholders), use mixed methods to identify unmet care needs of persons with AD/ADRD and their caregivers, and adapt Connect-Home to address those unmet needs while retaining fidelity to its program theory. In Aim 2, we will implement adapted Connect-Home tools and staff training in two SNFs and a home care agency and study (1) the feasibility of the adapted intervention (using adapted chart review measures from the parent study) and the (2) acceptability of the intervention (using surveys with 20 persons with AD/ADRD, their 20 caregivers, and staff). We also will study patient and caregiver outcomes of the adapted intervention using measures in the parent study (i.e., patient preparedness for discharge and preparedness for caregiving; patient quality of life, function, days of acute care use; and caregiver burden and distress).

Key facts

NIH application ID
10123392
Project number
3R01NR017636-03S1
Recipient
UNIV OF NORTH CAROLINA CHAPEL HILL
Principal Investigator
Mark P Toles
Activity code
R01
Funding institute
NIH
Fiscal year
2020
Award amount
$381,684
Award type
3
Project period
2018-07-25 → 2022-04-30