LEAD IT! An App to Enable Persons With Early Stage Dementia to Lead Group Activities for Their Peers

Approximately one million persons with dementia (PWD) reside in long term care (LTC), and this figure is expected to double over the next 20 years. Dementia interferes with a person's ability to function independently and is also associated with a variety of responsive behaviors. In fact, researchers have found that 97% of PWD exhibit at least one challenging behavior over the course of a five-year period. Persons with early stage dementia (PESD) also often experience an existential crisis, as they feel a loss of purpose in life. While the remaining strengths of PESD have been known for some time, few opportunities for meaningful social roles exist. So, there is an urgent need to create interventions that enable PESD to fill such roles and capitalize on their many remaining skills.

The product under consideration in this project addresses this critical need through the use of an evidence-based, resident-led group activity program. Since many PESD reside in LTC, the role of group activity leader is a sensible option for providing a meaningful social role. To this end, the Principal Investigator of this project managed two studies in which PESD served as group activity leaders for other PWD. These studies demonstrated that (1) PESD can successfully serve as activity leaders if appropriate materials/processes are used; (2) resident-led programming produced higher levels of positive engagement than staff-led activities-i.e., PESD were more effective than staff; (3) minimal training is needed for the resident-leaders (RLs) and all training must occur "on the floor"; (4) leaders found the roles meaningful; and (5) responsive behaviors were reduced in some leaders. In these studies, resident-led activities materials were hard-copy (paper-based) in nature. Despite the positive outcomes, resident-led programming was never commercialized or disseminated on a large scale, largely due to the hard-copy (printed) nature of the activity materials.

Given the success of resident-led programming, the increased prevalence of dementia, and the push for early detection of dementia, there is an urgent need and strong commercialization potential for a product that enables PESD to serve as group leaders in resident-led activities. Since high-speed internet, tablets, and apps have become ubiquitous, one promising way to deploy such a product is through a tablet-based app. With this in mind, in a Phase 1 SBIR, the Principal Investigator of this project developed and evaluated an Alpha Version of a tablet-based app called LEAD IT!, which enables PESD to implement resident-led activities. The Phase 1 project demonstrated that (1) PESD were capable of using the app to facilitate activities, (2) PWD participating in such activities-i.e., resident-players (RPs)-exhibited high levels of positive engagement, and (3) both RLs and RPs reported high satisfaction with the app. The proposed Phase 2 project will involve the further development and evaluation of LEAD IT!, as well as examine the clinical outcomes of long-term use of the app by both RLs and RPs.

The Specific Aims of the proposed Phase 2 project are to:

1. Develop improved Beta 1 and Beta 2 Versions of LEAD IT! with sufficient content to facilitate six activities twice per week for 4.5 months. During Months 1-7, the Beta 1 version of the app will be created by the study's Development Team (DT). During Months 13-15, the DT will create an improved Beta 2 version, based on lessons learned in Beta 1 testing.

2. Examine the extent to which RLs are able to serve as leaders while using LEAD IT! During all intervention sessions, researchers will track the extent to which each RL follows key steps involved in leading each activity. RLs will be considered successful if they follow the steps 80% of the time and require less staff assistance on less than 20% of steps.

3. Examine the effects of resident-led LEAD IT! programming on RPs. Two quasi-experiments will be conducted. Experiment #1, which will test the Beta 1 version of LEAD IT!, will use a pre-post design. Proximal (immediate) effects will be assessed by examining RP's levels of engagement/affect during baseline (standard) activities and again during LEAD IT! activities. It is hypothesized that LEAD IT! will result in higher quality engagement than baseline activities. Experiment #2, which will test the Beta 2 version of the app, will be a cluster randomized trial (CRT), consisting of pre- and post-intervention measurements of a Treatment Group (TG)-which will consist of PWD who receive the intervention - and a Control Group (CG) - which will consist of PWD who receive standard programming / care. Since Experiment #2 will occur after all improvements to the app have been made, it will represent the definitive trial of the LEAD IT! app's impact on PWD. For proximal (immediate) measures, it is anticipated that there will be a Group x Time interaction effect, with TG participants exhibiting significantly greater increases in positive forms of engagement, as compared to CG participants. For distal measures, it is anticipated that there will be a Group x Time interaction effect, with TG participants exhibiting significantly greater increases in quality of life (based upon the DEMQOL) at treatment, as compared to CG participants.

4. Examine PWD and staff satisfaction with LEAD IT! This will be achieved by eliciting feedback from PWD and staff members. PWD and staff members will be considered "highly satisfied" with the app if 85% are satisfied with the app.