Improving Person-Environment Fit of Community-Residing Older Adults with Dementia Through Assessment and Individualized Intervention

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Project Summary Aging with Alzheimer's disease and related dementias (ADRD) is compounded by onset of behavioral and psychiatric symptoms (BPSD) seen in over 80% of those with the condition. BPSD often precipitate caregiver burden, institutionalized care, and increased rates of mortality. Despite the critical need, there currently are few non-pharmacological interventions to manage BPSD and those that exist have weak evidence. Research: The project titled, Improving Person-Environment Fit of Community-Residing Older Adults with Dementia Through Assessment and Individualized Intervention, identifies person-environment relationships as a mechanism of action to guide assessment of and intervention for functional behavior within the home context for persons with ADRD. By improving the relationship between persons with ADRD and their home environment (person- environment fit), it is hypothesized that people with ADRD will have improved BPSD and activity engagement within their home. We will employ the NIH Stage Model of Behavioral Intervention Development to define assessment of person-environment fit (Stage 0; Aim 1) and pilot the feasibility of a telehealth intervention to maximize person-environment fit within the homes of community-residing adults with ADRD within rural communities (Aim 2). Findings of this research will inform discovery of best practices for a non-pharmacological, environmental approach to BPSD for persons with ADRD living in their home. Candidate: Dr. Elizabeth Rhodus is an early-career investigator, who is transitioning from a NIH T32-funded postdoctoral fellowship to a full-time tenure-track faculty position at the University of Kentucky (UK) College of Medicine. Three training goals will enhance her trajectory toward becoming an independent, successfully funded investigator: 1) Develop a strong knowledge base on integrated physiological and behavioral assessment of person-environment interactions on community-dwelling people living with ADRD, 2) Build expertise in development and implementation of behavioral interventions among older adults with ADRD, and 3) Expand understanding of research strategies for inclusion of underrepresented populations in aging studies. Mentors/Environment: The current career development plan includes substantial mentorship, didactic training, and experiential learning at the UK Center for Health Equity Transformation with Director, Dr. Nancy Schoenberg (primary mentor), UK Sanders-Brown Center on Aging with Associate Director, Dr. Donna Wilcock (co-mentor), Dr. Anton Porsteinsson (mentor), a prominent clinical researcher and psychiatrist for treatment of BPSD, and a renowned, interdisciplinary advisory committee. Dr. Rhodus will receive support from her institution through internal grants, faculty education, networking, and scholarship. Dr. Rhodus has full support from UK (see institutional letter of support) to advance her career development and research activities. Thus, the overall objective of this K23 application is to propel the career development of Dr. Rhodus to an independent scientist in ADRD research using the findings of this project to inform a future extramural R01 targeting non-pharmacological interventions for BPSD management.