The Institute of Medicine identifies sexual/gender minority older adults as one of the most underserved populations, with significant health disparities. This at-risk group faces serious barriers to healthcare access, bias in health settings, and a lack of culturally competent care. The number of sexual/gender minority older adults living with Alzheimer's disease and related dementias (AD/RD) and their caregivers (CGs) are growing rapidly, and will exceed 4 million by 2060. The lack of efficacious research-based interventions implemented to reduce disability and depression, and improve quality of life for these older adults living with AD/RD and their CGs,is a significant public health problem. Research has documented the protective role of CGs in the health of older adults living with AD/RD as well as CGs' hardships and challenges in caregiving and the impact of caregiving on health deterioration. Caregiving of such vulnerable older adults with AD/RD is particularly of concern due to this population's lower rate of cross-generational ties and their social stigma and isolation, which may be barriers to sustaining caregiving relationships. This project builds on the success of two major NIH projects, Aging with Pride: National Health, Aging, and Sexuality/Gender Study (2R01 AG026526; K. Fredriksen-Goldsen, PI) and Reducing Disabilities in Alzheimer's Disease (RDAD); R01 AG10845; L. Teri, PI) and will test the efficacy of an enhanced RDAD intervention for stigmatized populations addressing identity management, historical trauma and diverse peer support networks. The project will address the following aims:
Aim 1. Test the translation and enhancement of RDAD designed to increase physical activities of these vulnerable older adult CRs with AD/RD and their CGs .
Aim 2. Evaluate the short- and long-term effect of the enhanced and standard RDAD on primary (physical activity and functioning, perceived stress for CGs, institutionalization for CRs) and secondary outcomes (HRQOL, depressive symptomatology, behavioral disturbances for CRs).
Aim 3. Test the moderating roles of CR-CG characteristics, e.g., type of CR-CG relationship, sex, severity of CR AD/RD, on the treatment effect of the standard and enhanced RDAD. This team of nationally recognized experts has more than 20 years of conducting Alzheimer's and minority aging research, with the expertise and established relationships necessary to test the first evidence-based intervention for demographically diverse vulnerable older adults living with AD/RD and their CGs. The findings from this study will be fully disseminated through caregiving and aging agencies, community-based organizations, and research networks across multiple sites and settings.
Interventions to meet the health needs of sexual/gender minority older adults living with Alzheimer's Disease and Related Dementias (AD/RD) and their caregivers (CGs), as historically marginalized and underserved populations, are critically needed yet not developed. This study will test the translation and enhancement of the first community evidence-based dyadic caregiving intervention, Reducing Disabilities in Alzheimer's Disease, for these vulnerable older adults living with AD/RD to improve quality of life and reduce rates of institutionalization. The findings are critical in designing culturally tailored interventions and policy to respond to health disparities in Alzheimer's care in our increasingly diverse and growing older adult population.
