SAGE LEAF 2: An Online Self-Guided Positive Emotion Regulation Program to Reduce Alzheimer's Dementia Caregiver Burden Delivered through Caregiver-Serving Organizations - Project Summary
In the US alone, more than 11 million family caregivers provide care for someone with Alzheimer's
disease or other dementia on a daily basis.1 These family caregivers have been estimated to
shoulder 70% of the total cost of care over their care recipient’s lifetime, costs which include
medical bills and unpaid caregiving hours.2 Caregiving-related stress contributes to social
isolation, loneliness, and physical illness and increases the risk of caregiver death.3-7 Currently,
most caregiver interventions focus on reducing burden, stress, and negative emotions. However,
a growing body of research from our team and others demonstrates that positive emotion is
uniquely associated with beneficial health outcomes, independent of the effects of negative
emotion,8-12 and holds promise for countering the negative psychological and physical health
effects of caregiving. We developed and tested a facilitator-delivered positive emotion regulation
intervention for dementia caregivers that showed significant improvements in positive emotion,
positive aspects of caregiving, depression, and anxiety compared to an emotion reporting waitlist
control.13 However, the expense of facilitator delivery poses challenges to the implementation,
dissemination, and commercialization of LEAF. Online self-guided programs are more easily
disseminated, however, they generally lack a social connection which, given the high rates of
loneliness and social isolation among dementia caregivers,14,15 is problematic. In phase I of this
program of research (R43AG065080; Yang and Moskowitz, MPI), we tailored a self-guided online
positive emotion regulation intervention (called SAGE LEAF - Social Augmentation of self-Guided
Electronic delivery of the Life Enhancing Activities for Family caregivers) by incorporating social
connection components for caregivers going through the program individually (vs in groups; See
Phase I progress report). Interviews and focus groups with caregivers indicated a desire for SAGE
LEAF to host interactions within cohorts of caregivers participating at the same time. A proof-of-
concept study indicated that the SAGE LEAF prototype was feasible and acceptable. Caregivers
rated the social enhancements as moderately usable and suggested ways to make the features
more visible on the user dashboard. In the proposed Phase II project, we will further develop
SAGE LEAF to include features to foster implementation by clinics, care centers, and other
caregiver-serving organizations (CSOs) for groups of caregivers to leverage the benefits of social
connections within the virtual SAGE LEAF environment and will conduct a pragmatic trial in which
SAGE LEAF is implemented through the CSOs.
