Collaborators: Kira Birditt (PI), Sung Won Choi (Co-I), Noelle Carlozzi (Co-I)
Funding: Network for Innovative Methods in Longitudinal Aging Studies/Michigan Center on the Demography of Aging
Project Summary: Approximately 11 million Americans provide unpaid caregiving to people living with Alzheimer’s disease and related dementias (ADRD), and unpaid caregivers are increasingly vital in the long-term care of this vulnerable population. As care responsibilities accumulate, caregivers face health risks, including anxiety, burden, sleep problems, decreased physical activity, and chronic illness. These risks, in turn, may harm the mental and physical health of care recipients. Thus, it is imperative to identify modifiable factors that influence caregiver and care recipient mental and physical health to target in personalized interventions. Multiple Principal Investigator Choi developed a mobile health intervention app (Roadmap; R01HL146354) that encourages individuals to engage in positive activities with demonstrated feasibility, acceptability, and efficacy in caregivers across multiple populations. The Roadmap app has the potential to be a scalable, personalized intervention for improving the mental and physical health of ADRD caregivers and care recipients. This microrandomized trial will provide data to test our newly developed Positive Activities and Daily Mental and Physical Health among ADRD Caregiver-Care Recipient Dyads Model, which suggests that prompts to engage in positive activities will improve mental and physical health among ADRD caregivers and care recipients via behavioral activation to engage in positive activities, better caregiver mood, and improved quality of interactions with the care recipient. Participants will include 200 ADRD caregiver-care recipient dyads (N = 400; 70 percent White, 30 percent racial/ethnic minority; 70 percent female caregivers, including spouse, adult child, and other caregivers). Caregivers will complete: 1) a baseline phone interview, 2) two-weeks of intensive data collection which includes microrandomized prompts to engage in Roadmap positive activity each morning (8 AM; 0.50 probability of prompt versus. no prompt) and evening (6 PM, 0.50 probability of prompt versus. no prompt), completing ecological momentary assessments (EMAs) two times a day (at 10 AM and 8 PM), while continuously wearing a Fitbit®. Care recipients will: 1) complete a cognitive assessment and 2) wear a Fitbit® for two weeks. EMAs will include reports of positive activities, caregiver mental and physical health and caregiver proxy reports of care recipient mental and physical health, caregiver mood, and quality of interactions with care recipients. Fitbit® measuresl include physical activity, sleep (quality, duration), and heart rate. We will test the following aims: Aim 1 (primary): Assess the effects of receiving a prompt to engage in a Roadmap app positive activity (versus. no prompt) on ADRD caregiver and care recipient daily mental and physical health. Aim 2 (secondary): Investigate behavioral activation (i.e., positive activity engagement), mood, and improved quality of interactions as the key mechanisms of action. Aim 3 (exploratory): Identify for whom and under what conditions the prompts to use the Roadmap app are most beneficial. Impact: This study will provide key insights into the app’s usefulness and scalability, which can be made widely available to caregivers.