Assessing a Novel Virtual Environment that Primes Individuals Living with AD/ADRD to Accomplish Activities of Daily Living.

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ABSTRACT The prevalence of Alzheimer’s disease and related dementias (ADRD) is growing in an increasingly aging population. Care challenges to maintain health and quality life for persons living with dementias (PLWD) has also created a parallel health problem from the effects of persistent caregiver job stress, resulting in staff turnover expense and care operations risk in a scarce job pool. Improving the rate of completion of Activities of Daily Living (ADL) has a known positive impact on the quality of life, health, and healthcare costs yet consistently completing ADLs, and without stress, for PLWD and their carers remains a challenge. We hypothesize that undertaking virtual ADL activities will positively impact actual ADL activities, resulting in easier and more efficient ADL completion and therefore decrease caregiver stress, and, with dignity, improve the health and quality of life for PLWD. Mentia is an early-stage digital health company that has developed DevaWorld™, a novel technology platform focused on improving behavioral health for people impacted by ADRD. DevaWorld, as an assistive software application technology, is unique in that it considers care as a partnership, with the care recipient being an active participant, even though their dementia may be severe. The cost-effective platform consists of a media-rich 3D virtual home with interactive items and activities that can be used to build communication within the care dyad and foster a sense of agency and identity. The goal of the proposed work is to demonstrate tolerability and acceptability of DevaWorld, and assess the impact of virtual ADL activity on both partners of the dyad, paying special attention to how consistent performance of ADLs inside DevaWorld by PLWD reduces caregiver stress. In this work, two specific aims are proposed: Aim 1: Expand DevaWorld to include environments and activities most often cited as challenges in regard to ADLs. We hypothesize that players can be prepared to perform ADLs via virtual world interactions. This aim entails the design of settings, activities, and interactive avatar actions within DevaWorld intended to prepare the player in selected ADLs. Aim 2: Demonstrate feasibility and acceptability of DevaWorld in a feasibility study. Qualitative measurements using ecological momentary assessments (EMAs) and quantitative measurements of independence through activities of daily living (ADL) scale assessments will be assessed while 16 players with ADRD undertake virtual and real-world ADLs (AIM 1) (single group study). The primary outcome of this aim is tolerability and acceptability of DevaWorld assessed by caregiver surveys and EMAs. The secondary outcome is feasibility and efficacy of preparing ADLs using DevaWorld assessed by AMMODE, validated caregiver surveys of stressors and ADL scale assessment scores.