MEMORI Corps: Activity-based Companion Care for Dementia (MEMORI Corps)

MEMORI Corps: A Novel Activity-based Companion Care Program to Benefit Community-living Persons With Dementia, Their Families, and Senior Volunteers

This is a single blind, intention-to-treat, randomized controlled trial design to evaluate the feasibility and efficacy of a 12-week, evidence-based, individualized MEMORI Corps program delivered by trained older volunteers (n=80) to community-living PWD/CG dyads (n=240). Eligible PWD/CG dyads will be randomized to receive 12-weeks intervention group (n=120), or 12-week augmented waitlist control group (n=120) followed by 12-weeks of intervention. Eligible volunteers will be randomized to 12 months of MEMORI Corps active duty (n=40) where the participants will be matched to three families over the course of a year, or a 12-month augmented waitlist control group (n=40) followed by opportunity to serve 12 months active duty in MEMORI Corps. Program goals are to address unmet respite care needs for family caregivers, provide persons with dementia meaningful evidence-based activity programming, as well as provide health benefits, meaningful productive engagement, and peer support opportunities for senior volunteers.

In partnership with the Alzheimer's Association, the investigators propose to evaluate in a NIH Stage III (Real World Efficacy) randomized trial, Making Engagement Meaningful through Organized Routine Interaction (MEMORI) Corps, a novel 12-week activity-based companion care model, to mobilize and equip a critical mass of senior volunteers to deliver individualized, evidence-based activity programming to PWD living at home and offer family CGs needed respite. Synthesizing and adapting prior evidence-based work from the Tailored Activities Program® (a proven activity-based intervention to address functional decline and behavioral symptoms in persons with dementia), Experience Corps® (an inter-generational civic engagement program that engages senior volunteers to work in elementary schools to improve academic outcomes for children and improve health outcomes for the volunteers), and MIND at Home® (a home-based dementia care coordination program delivered by non-clinical care coordinators supported by a clinical team), MEMORI Corps takes a social model of health approach to simultaneously address unmet respite care needs of family CGs, provide PWD structured meaningful activities and social engagement, and provide meaningful engagement and peer support opportunities for senior volunteers-creating potential for a "win-win-win" scenario. This single blind, two-arm, randomized controlled trial will evaluate the feasibility and efficacy of a 12-week, evidence-based, individualized MEMORI Corps program delivered by trained senior volunteers (n=80) to community-living PWD and participant's family caregivers (n=240 dyads). Core intervention components include: (1) detailed initial home-based assessment of interests and preserved abilities of PWD; (2) individualized activity program plans based on interests and abilities; (3) training of volunteers in communication and simplification strategies and use of activity program plans; (4) delivery of activity plans by volunteers to PWD over 12 weeks (8 hours/week) in participant's homes; (5) family CG education on activity plans and ways to utilize respite opportunities; and (6) support of volunteers from a skilled multidisciplinary clinical team. PWD/CG outcomes will be assessed at baseline, 6-, and 12-weeks. Volunteer outcomes will be assessed at baseline, 6- and 12-months (volunteer participation lasts 12 months). Specific aims are to evaluate the: Aim 1: Efficacy of the MEMORI Corps intervention on community-living PWD quality of life and neuropsychiatric symptoms at 6- and 12-weeks (primary endpoint) versus augmented wait-list control. Aim 2: Efficacy of MEMORI Corps intervention on CG subjective and objective burden and depressive symptoms at 6- and 12-weeks (primary endpoint) versus augmented wait-list control. Aim 3: Efficacy of MEMORI Corps intervention on volunteer physical function, cognition, and social and psychological engagement at 6-months and 12-months (primary endpoint) versus augmented wait-list control. Aim 4: Acceptability and feasibility of implementing the MEMORI Corps program from various stakeholder perspectives (PWD, informal CGs, senior volunteers, volunteer coordinators/supervisors).

dementia care, community-based, companion care, activity, caregiver wellbeing, caregiver respite, caregiver support, home-based, volunteer

Activity-based companion care program. Delivered by trained senior volunteers, supported by a clinical team, over a 12-week intervention period (8 hours per week, 2 or 3 days per week) for each person with dementia/family caregiver dyad. Primary roles of the volunteers are to provide in-home supervision, peer-to-peer companionship, and a evidence-based individualized activity program that focuses on meaningful, engaging and enjoyable activities that match PWD abilities and interests.

Single blind randomized controlled trial where outcome assessors are masked to treatment arm allocation.

Activity-based companion care program. Delivered by trained senior volunteers, supported by a clinical team, over a 12-week intervention period (8 hours per week, 2 or 3 days per week) for each person with dementia/family caregiver dyad. Primary roles of the volunteers are to provide in-home supervision, peer-to-peer companionship, and a evidence-based individualized activity program that focuses on meaningful, engaging and enjoyable activities that match PWD abilities and interests.

Persons with dementia/caregivers will continue any services and supports being used, will receive a free copy of "A Caregiver's Guide to Dementia: Using Activities and Other Strategies to Prevent, Reduce and Manage Behavioral Symptom"103), written educational materials on management of CG stress/well-being, and bi-weekly check-in calls to answer any questions about the materials. Volunteers randomized to waitlist control will continue with usual activities (volunteer or other), and will receive additional written educational materials on cognitive health (NIA) and exercise and Physical Activity (Go4Life), referrals to the Baltimore City Commission on Aging and Retirement Education for volunteering opportunities, and bi-monthly check-in calls to answer questions and maintain engagement. Waitlist dyads will be followed at specified intervals by the research team and then offered an opportunity for participation in the intervention arm.

The total score (frequency x severity) of the Neuropsychiatric Inventory (NPI) scale will be used to measure neuropsychiatric and behavioral symptoms. The NPI is a proxy rating of person with dementia's severity, frequency, and distress across 12 types of neuropsychiatric behavior problems. Scores can range from 0-144, with higher score indicating greater neuropsychiatric behavioral burden.

The total score (sum of all items) for the Quality of life in Alzheimer's Disease (QOL-AD) tool will assess quality of life in the context of Alzheimer's Disease. The QOL-AD has a self-rated and proxy-rated version for persons with dementia, and was specifically developed for use in dementia. Scores can range from 13-52, with higher scores indicating better quality of life.

The total score (sum of items) for the Zarit Burden Inventory-Short Form-12 items (ZBI) will assess subjective caregiver burden. The ZBI short form is a self-rated 12-item measure of caregiver subjective burden rating related to caregiving for persons with dementia. Scores can range from 0-48, with higher scores indicating greater perceived burden.

Change in depressive symptoms in caregivers as assessed by The Patient Health Questionnaire (PHQ) - 9

The total score (sum of items) for the The Patient Health Questionnaire (PHQ) - 9 will assess depressive symptoms severity. The PHQ-9 is a self-rated 9 item measure of caregiver depressive symptoms. Scores can range from 0-27, with higher scores indicating greater depressive symptoms.

The total score for the Pattern Comparison test will be used to assess speed of processing changes. The Pattern Comparison test is a neuropsychological test to measure volunteer cognitive speed processing. Higher scores indicate greater speeds of processing.

The time (minutes) it takes subjects to rise from a chair, walk 4 meters, turnaround and sit back down will be used to assess gait speed. This walking speed test to measure volunteer gait disability. Lower time scores indicates better gait functioning.

The score for the Trail Making Test B will be used to measure volunteer executive functioning. Lower time score indicates better executive functioning.

Change in activity engagement as assessed by the Community Healthy Activities Model Program for Seniors activity questionnaire

The total score from the Community Healthy Activities Model Program for Seniors activity questionnaire will be used to quantify engagement in various forms of activities over the course of a week. Scores can range from 0-168, with higher scores indicating greater activity engagement.

Change in outpatient health services use as assessed by the Resource Utilization in Dementia/Services Utilization and Resources Survey

This is a proxy rated measure (Resource Utilization in Dementia/Services Utilization and Resources Survey; SURFS) of family caregiver outpatient medical services. Total scores are for each category and represent counts of service type encounters (range 0-90) for outpatient medical services, with higher counts indicating more service type utilization.

Change in home and community-based long term services and supports use health services use as assessed by the Resource Utilization in Dementia/Services Utilization and Resources Survey

Community based long term services and supports is summarized by count of service type category, ranging from 0-12, with higher counts indicating more service category utilization.

Two individual items ask caregivers to estimate hours per day spent doing caregiving activities, and hours per day spent with the person with dementia in a typical week. Objective measure of caregiver burden. Higher time estimates in performing these tasks indicate greater objective burden.

The investigators will use a total score of the Elders Life Stress Inventory to measure stress ratings by volunteers. The total score ranges from 0-31 and indicates the total sum of 31 different types of stressful life events over the observation period related to several domains of the persons life. Higher counts of stressful events represent greater stress.

The investigators will record the time (days) from randomization to transition from home using survival analyses. These exploratory analyses will estimate risk of all-cause transition out of home for person with dementia

Change in depressive symptoms in senior companion volunteers as assessed by The Patient Health Questionnaire (PHQ) - 9

The total score (sum of items) for the The Patient Health Questionnaire (PHQ) - 9 will assess depressive symptoms severity in senior companion volunteers. The PHQ-9 is a self-rated 9 item measure of caregiver depressive symptoms. Scores can range from 0-27, with higher scores indicating greater depressive symptoms.

Inclusion Criteria: Persons with dementia and informal caregiver (PWD/CG) must both meet eligibility criteria. These criteria are designed to reduce PWD/CG attrition and ensure safety of PWD, CG, and volunteers. PWD are eligible if: English speaking Have an established physician clinical diagnosis of dementia (any stage) and confirmed with the Clinical Dementia Rating Scale of >0.5 Are able to participate in >2 basic Activities of Daily Living Have not received formal (e.g. in-home companion care, or adult day center) respite care services in the past 4 weeks Living at home in Baltimore City or Baltimore County. CGs are eligible if: English speaking 18 years of age or older (male or female) Are deemed to be a reliable informal caregiver (not paid for their care-giving) Are co-residing with the PWD Are relied on by the PWD for assistance in activities of daily living (instrumental or basic). Volunteers are eligible if: English-speaking 55 years or older Ability to read Ability to pass a criminal background check, drug and physical and mental health screening Have reliable transportation and able to travel within 20 miles of home A Mini-Mental State Examination score of 24 or above Ability to complete the Trail Making Test within specified time limits Ability to commit to 12 months of service (10 hours per week excluding travel time) Are reliable during intake and on-boarding process. Exclusion Criteria: PWD are excluded If deemed to be in a crisis/unsafe situation at baseline Planned transition from home in less than 6 months At end-stage disease (e.g. bed-bound, non-communicative, or hospice) Are incontinent of urine or bowels Are currently enrolled in a dementia related clinical trial Deemed to have severe behavioral symptoms placing self or others at harm. CGs are excluded if: Do not plan to be co-residing with the PWD in the next 6 months Are currently involved in a behavioral/educational clinical trial. Volunteers are excluded: Are planning on moving from the area in the next 12 months Unable to provide informed consent.

Results and learning from this Phase III randomized controlled trial (RCT) will be strategically disseminated to a variety of stakeholders (persons with dementia, family caregivers, partners, advocacy organizations, volunteer organizations, community-based organizations, state and federal policy makers, regulators, health and supportive care services providers, health organizations and health system decision makers) and in a variety of formats (peer reviewed publications, professional and scientific conferences, community lectures, popular press articles, briefs, blog posts). Messaging will be specifically tailored to stakeholder groups to support the effective communication of the science and key findings.