Abstract (Overall)
Living alone has emerged as a risk factor for Alzheimer’s disease (AD) and related dementias (ADRD) that will
affect 14 million Americans, particularly African and Hispanic Americans. A third of community-dwelling older
adults with ADRD live alone, but there are limited interventions to help them live alone safely and for as long as
they desire. Growing research have shown that behavior and lifestyle Interventions can improve cognition,
physical function, and quality of life (QoL) in older adults with cognitive decline (defined as subjective cognitive
decline [SCD], mild cognitive impairment [MCI], or ADRD). However, the real-life uptake of these interventions
has been low because the interventions did not target Mechanisms of Behavior Change (MoBC) and older
adults living alone with cognitive decline and minorities were often excluded by clinical trials. These issues can
be addressed with technology. Hence, the goal of the Arizona State University Roybal Center for Older Adults
Living Alone with Cognitive Decline (ASU Roybal) is to develop infrastructure and conduct clinical trials of
MoBC-driven, technology-enabled interventions to delay ADRD and improve quality of life (QoL) in older adults
living alone with cognitive decline. It is guided by a conceptual framework integrating the NIH’s Stage Model,
MoBC, Symptom Science Model, and NIA’s Health Disparities Research Framework. It hypothesizes that
technology-enabled interventions driven by MoBC (e.g., stress) or biological targets (e.g., inflammation) can
improve proximal (e.g., cognition, emotional wellbeing) and long-term outcomes (e.g., ADRD prevention) in
older adults living alone with cognitive decline. For example, Trial 1 (Stage IB) will focus on MoBC targets of
social support and stress to increase physical activity in older adults living alone with SCD and Trial 2 (Stage I)
on MoBC targets of interpersonal/social processes to improve emotional wellbeing in those with early AD. ASU
Roybal will be co-led by experienced senior scientists who are experts in ADRD, MoBC, behavioral trials,
technology, and administration. The Administrative Core will develop infrastructure, administer Call for Trials,
and evaluate and sustain ASU Roybal’s long-term impact. The Behavioral Intervention Development (BID)
Core will support the design, conduct, and advancement of 12 trials. The Specific Aims are to 1) build the
infrastructure to conduct clinical trials of MoBC-driven, technology-enabled interventions for behavior and
lifestyle change and across the NIH’s Stage Model in older adults living alone with cognitive decline; 2)
facilitate the design and conduct of 12 trials to test interventions’ effects on mechanistic, proximal, and long-
term outcomes in older adults living alone with cognitive decline; and 3) sustain the long-term impact of MoBC-
driven, technology-enabled intervention research on older adults living alone with cognitive decline. ASU
Roybal matches the FOA Thematic Area in targeting MoBC to promote behavior and lifestyle change and is in
line with the National Research Summit recommendations. It will test innovative technology-enabled
interventions in a growing but overlooked population—older adults living alone with cognitive decline.
