Improving Self-Care of Caregivers of Adults in Homecare with Heart Failure and Cognitive Impairment - Cognitive impairment (CI) has been reported to be as high as 78% in older adults with heart failure (HF). Patients with both HF and CI are rarely able to manage without a caregiver. The demands of caregiving for someone with HF/CI are high and cause stress in caregivers and strain in the relationship, which leads to negative social exchanges, poor coping, and lower mental health in caregivers. Anxiety, depression, and somatic symptoms are common in patients with HF and relationship strain can make these symptoms worse. Support interventions can decrease stress in caregivers. We demonstrated efficacy of a 10-session virtual health coaching intervention, Virtual Caregiver Coach for You (ViCCY), for caregivers of adults with HF (R01-NR-018196) that focused on increasing caregiver self-care. ViCCY was successful in improving self-care and decreasing stress in a sample of 250 caregivers recruited from a large urban regional referral center for advanced HF care. However, the caregivers were primarily white (62.2%) women (85.2%) with adequate financial resources (82.3%) and the patients were principally men with few comorbid conditions; only 10% had mild CI. Now that we have shown efficacy in this first Stage II trial, we aim to expand testing to a broader, more challenging population of underserved caregivers of patients with HF/CI. In the proposed trial we will enroll 254 caregivers supporting patients with HF/CI from home health care (HHC). We will also enroll at least 60 patients with HF and mild or moderate CI (30/study arm). In New York City, where this study will be conducted, many of the patients referred to HHC are older adults from wide-ranging populations with a variety of chronic conditions including HF/CI. We will enroll caregivers of older HHC patients with HF/CI with poor self-care and poor mental health, purposefully seeking a varied sample. Using a Stage II randomized controlled trial (RCT) design, we will randomize caregivers 1:1 to ViCCY or a usual care (UC) control group. At baseline, 3, 6, and 12 months, we will collect self-reported data from caregivers and patients to assess intervention efficacy and sustainability using intent-to-treat analysis. Having demonstrated that ViCCY improves mechanistic outcomes at 6-months in the first RCT, here we will focus on mental health as the primary outcome in caregivers. Enrolling patients will allow us to explore whether an intervention for caregivers can improve outcomes in patients. Mechanistic analyses will be used to explore which kinds of changes in caregivers translate into changes in patients. Specific Aims are to test the efficacy of ViCCY vs. UC in improving outcomes of caregivers of HHC patients with HF/CI, explore the effect of ViCCY on outcomes in HHC patients with HF/CI, and describe the mechanisms by which outcomes are achieved. This application aligns with NIA’s Notice of Special Interest on Behavioral and Social Science Priority Areas in Dementia Care Partner/Caregiver Research (NOT-AG-21-047). If ViCCY is efficacious in caregivers assisting HHC patients with HF/CI, this will be further evidence that ViCCY may be able to address a need for support for millions of caregivers worldwide.
