Home Alone: Developing a Home-Based Intervention for People with Cognitive Impairment Who Live Alone

Project Abstract Descriptive research suggests that living alone with cognitive impairment (CI) is associated with many complex challenges, such as a lack of available and accessible services to facilitate living independently, and an elevated risk of hospitalization and institutionalization. Additionally, almost half of older adults who live alone with CI experience difficulty with a basic or instrumental activity of daily living. However, there are few interventions designed to assist older adults with CI who live alone to help them remain socially engaged in their existing living environment. We propose to develop a novel home-based intervention, called Home Alone, for persons living alone with CI (defined here as someone diagnosed with mild cognitive impairment/MCI or as someone with cognitive impairment without dementia as established on a validated telephone-based screener). Home Alone is a seven-module home-based program that is adapted from established, evidence- based mental health and dementia care interventions (behavioral activation, Skills2Care®, and the Tailored Activities Program). This proposed R21 will examine the feasibility, acceptability, and usefulness of Home Alone to assist persons living alone with CI or AD/ADRD to successfully navigate the challenges of living independently with dementia. The Specific Aims are: to 1) develop and adapt Home Alone for pilot testing among 15 persons with CI who live alone over a 3-month period. A convergent parallel mixed methods design will be utilized to determine whether various elements of Home Alone (e.g., delivery mode, length, and other intervention characteristics) require adaptation; and 2) pilot-test a revised version of Home Alone over a 6- month period among 50 participants living alone with CI. A sequential explanatory mixed methods design will be utilized to do so. We will determine whether Home Alone is carried out as intended and is deemed feasible, acceptable, and useful. The development of this theory- and evidence-informed intervention will directly address the need for further understanding of how to support people living alone with CI. If successful, the proposed R21 will position Home Alone for a subsequent randomized controlled evaluation and later as a flexible, much-needed evidence-based resource that is scalable for healthcare systems and dementia support programs.