The primary goal of this proposal is to establish the feasibility, acceptability, and
appropriateness of a novel intervention, "Home Alone." Home Alone will be targeted to
older persons with CI or Mild Cognitive Impairment (MCI) who live alone in the community.
This National Institute on Aging (NIA) Stage I effort will adapt and tailor established,
evidence-based mental health and dementia care intervention models (behavioral
activation, Skills2Care®, Tailored Activity Program) to reduce environmental stress and
enhance engagement in desired activities to improve social well-being and maintain
cognition and function for those who live alone with CI. Relying on a robust, mixed
methods strategy and an implementation science lens at the outset of intervention
development, the investigators seek to position Home Alone as a scalable program that, as
its efficacy and effectiveness is determined in subsequent trials, is primed for
widespread dissemination and adoption in home-based and community contexts.
The Specific Aims are as follows:
Specific Aim 1 (Phase I): Develop and Adapt Home Alone to Prepare for Pilot Testing. The
investigators will identify treatment components and examine feasibility and relevance by
obtaining insights from 15 persons with CI who live alone and participate in the Home
Alone intervention over a 3-month period. The investigators will utilize the Phase I
period to determine whether various elements of Home Alone (e.g., delivery mode, length,
and other intervention characteristics) require adaptation. The investigators will use a
convergent parallel mixed methods design (i.e., the collection and analysis of
quantitative and qualitative data concurrently) when doing so. Through analysis of the
various quantitative and qualitative data elements to inform adaptation, the
investigators will finalize and refine Home Alone prior to project Phase II (Specific Aim
2).
Specific Aim 2 (Phase II): Pilot Test a Revised Version of Home Alone. This R21 project
will evaluate the following indices of implementation potential over a 6-month period:
whether Home Alone is carried out as intended and is feasible (the degree to which Home
Alone can be successfully delivered); acceptable (Home Alone is agreeable and
satisfactory among users), and useful (participants perceive benefit from the Home Alone
intervention). A sequential explanatory mixed methods design (a quantitative component
followed by a qualitative component) will be utilized to pilot test Home Alone. The
investigators will enroll 50 persons living alone with CI over a 6-month period. The
investigators will also examine whether key empirical outcomes (perceived loneliness;
activity engagement; measures of cognition and functional dependence) change over a
6-month period. Available qualitative data will provide information on how and why Home
Alone was beneficial or not for persons with CI and allow for greater understanding of
the intervention's mechanisms of benefit.
Home Alone combines Behavioral Activation (BA) with other evidence-based intervention
approaches (i.e., Tailored Activity Program (TAP); Skills2Care®) that target the
environment in order to tailor activity that is fulfilling and meaningful to persons with
CI. An additional intervention component that will be incorporated in Home Alone includes
environmental assessments that help the person with CI by removing objects and improving
lighting and safety in areas of the home where a desired and meaningful activity will be
conducted.