# CARES: A Caregiver-Facing Digital Symptom Assessment Tool for Marginalized Older Adults with Serious Illness

> **NIH NIH K76** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2024 · $242,992

## Abstract

PROJECT SUMMARY
This K76 proposal describes the five-year career development plan of Dr. Sarah Nouri, an Assistant Professor
in the Division of Palliative Medicine at the University of California San Francisco (UCSF). Dr. Nouri's long-term
career goal is to become a leader in ensuring equitable access to high-quality serious illness care for
marginalized older adults. Millions of older adults in the US have serious illness and suffer due to poorly
controlled symptoms, such as pain and shortness of breath. These symptoms are difficult to monitor and often
result in emergency room visits, particularly for the >7 million homebound older adults who rely on caregivers.
Homebound older adults are more likely to have cognitive impairment or Alzheimer's Disease or Alzheimer's
Disease Related Dementias (CI/ADRD), be economically disadvantaged, and be racially or ethnically
minoritized. Caregivers experience distress related to older adults' symptom burden because of challenges
assessing symptom severity and knowing when and how to reach out to patients' primary care teams for
support. Dr. Nouri previously evaluated a caregiver-facing, paper-based Symptom Assessment (SA) Toolkit
and found it was acceptable and usable. However, study participants reported needing: 1) support for
CI/ADRD-unique neuropsychiatric symptoms (e.g., behavior and sleep disturbances), 2) clarification of primary
care workflows for symptom follow-up, and 3) a digital solution. Other remote symptom tools focus on people
with cancer and not older adults, exclude those with CI/ADRD, are not caregiver-facing, and were not created
with racially, ethnically, or socioeconomically diverse populations. To address these gaps, Dr. Nouri proposes
co-development and evaluation of a digital symptom assessment tool with caregivers and primary care teams
of homebound, Medicaid-enrolled older adults with serious illness (including CI/ADRD). The aims are to: 1)
adapt the SA-Toolkit content to include unique CI/ADRD-related symptoms and define an ideal implementation
strategy, 2) co-design a digital Caregiver Empowerment and Symptom Assessment tool (CARES) with
caregivers and primary care teams, and 3) conduct pilot feasibility testing of CARES. These objectives support
Dr. Nouri's career development activities focused on implementation science: 1) advanced qualitative methods,
2) intervention development with user-centered design methods, and 3) randomized trial design. Dr. Nouri will
conduct all work at UCSF with an exceptional mentoring team led by Dr. Rebecca Sudore. This proposal will
provide Dr. Nouri with the training and resources to develop the first digital symptom assessment tool to
empower caregivers of homebound older adults, including those with CI/ADRD. It will also lay the groundwork
for a randomized controlled trial of CARES and continued development of novel care delivery models to meet
the growing serious illness care needs of older adults. It will also provide advanced research and ...

## Key facts

- **NIH application ID:** 10954085
- **Project number:** 1K76AG088348-01
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Sarah Nouri
- **Activity code:** K76 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $242,992
- **Award type:** 1
- **Project period:** 2024-08-16 → 2029-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10954085

## Citation

> US National Institutes of Health, RePORTER application 10954085, CARES: A Caregiver-Facing Digital Symptom Assessment Tool for Marginalized Older Adults with Serious Illness (1K76AG088348-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10954085. Licensed CC0.

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