The use of Internet-connected devices to predict health problems and support aging in place by passively monitoring older adults is growing faster than our understanding of how to help families make decisions about how and when to use them. These technologies? surveilling nature can cause conflict and endanger values that are important to people with cognitive impairment, such as autonomy, privacy, control, and freedom. The objectives of this study are to develop and test the feasibility and preliminary effectiveness of a communication and education tool for passive remote monitoring use with older adults at early stage Alzheimer's disease and AD-related dementias (AD/ADRD) and their caregivers. This work is significant because it will advance scientific understanding of how to engage people with cognitive impairment in decisions while helping families to navigate the complex technology landscape. The candidate has conducted successful pilot work using an innovative method for communicating the basic functions of these technologies with frail, older adults to achieve comprehension so they can participate in decisions about them. The proposed project will build on this promising communication research to develop a tool to guide patients and their caregivers through a discussion about what technologies are acceptable and under what conditions they should be used. The Identifying Needs For Optimal Remote Monitoring tool will be modeled after advance care planning and will conclude with documented preferences. To generate the best input for the tool, technology and aging experts from academia and industry will identify the most suitable technology features and options to be included in the tool using the Delphi approach (Aim 1). Prevalent patient-centered preferences for these technologies will then be identified through surveys with older adults with and without diagnosed mild cognitive impairment (Aim 2). The tool will integrate these findings and it will be tested in a mixed methods feasibility study with 30 early stage AD/ADRD care dyads to assess preliminary effectiveness for ensuring comprehension, identification of patient preferences, preparation to make decisions as AD/ADRD progresses, and other key positive dyad outcomes (Aim 3). This research is responsive to the priority areas of NIA of improving communication, education, decision-making, planning, and stress reduction for caregivers and people with AD/ADRD and advancing technologies to reduce unnecessary care transitions and enable aging in place. The candidate is an Assistant Professor of Social Work at the University of Washington whose long-term career objective is to improve the ability of older adults with AD/ADRD to remain living at home safely with autonomy. The K01 would enable her to establish an interdisciplinary research program focused on improving health outcomes for older adults and caregivers by promoting the effective use of technologies for older adults with cognitive impairment. The proposed study advances this work by ensuring that we are integrating technologies in ways that respect older adults? values and dignity so their benefits of prolonging independence are realized.
This research will produce a communication and education tool to support family decision making about technologies that monitor older adults? activity to enhance fall detection, emergency response, independence, and postponement of institutionalization. The study will advance scientific understanding of how to engage people with early stage cognitive impairment in planning for how they will be monitored to reduce risks to their privacy and autonomy. Effectively involving older adults in these decisions and informing caregivers of their preferences will enable families to experience the benefits of these technologies and improve the health and well-being of patients and caregivers.