Improving Care Transitions and Self-care among Informal Caregivers of Hospitalized Older Adults through Digital Tools

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Informal caregiving is demanding and stressful especially when dealing with a hospitalization. Many caregivers eventually become care recipients themselves as years of stress and deferred self-care put them at increased risk for illness. Self-care refers to the behaviors undertaken to maintain health and manage illness. Engaging in self-care may improve health status (physical functioning and mental well-being). Older adults with multiple chronic conditions (MCCs) often depend on caregivers for assistance, especially after a hospitalization, when caregivers are often expected to follow complicated discharge plans and manage complex skilled care at home. The impact of care gaps and breakdowns saps time for self-care and causes significant stress for caregivers. Health coaching, a support intervention, can improve self-care in patients, but studies evaluating caregivers and racial differences are limited. Less is known about the effect of caregiver support interventions on patient outcomes. Leveraging the growing availability and declining costs of technology and internet access—along with increasing receptivity of virtual care in the wake of COVID-19—we developed and tested a synchronous virtual support intervention, ViCCY (Virtual Caregiver Coach for You), where 10 video conference sessions are delivered by a trained coach over six months that focus on self-care, coping, and stress. In this application, we propose to augment the ViCCY protocol to target caregivers during an acute care episode (during/post- hospitalization) and transitions in care for older adults with MCCs compared to digital health information (DHI) alone (control group). Using a randomized controlled trial (RCT) design, we will enroll informal caregivers with poor self-care (Health Self-Care Neglect scale score ≥2), and block randomize the caregivers 1:1 to the intervention or control group, stratifying randomization by caregiver sex, race, and relationship to the patient. Both groups will receive DHI delivered through a website tailored with care transitions and self-care information, and the intervention group will also receive ViCCY. At baseline, 3-, and 6-months, we will collect self-reported data on self-care, stress, coping, and health status. At 1-month post-hospital discharge the care transitions experience will be collected. At 6-months, we will compare ViCCY to DHI alone to assess intervention efficacy using intent-to-treat analysis. A sample of 250 caregivers (125/arm) will provide >80% power to detect significant differences between the groups on the primary outcome of self-care (Aim 1) and that the magnitude of improvement will be similar in outcomes in Aim 1 between Black/AA and White caregivers (Aim 2). To explore the effect of caregiver outcomes on patients’ outcomes we will examine acute care resource use (rehospitalization, etc.) over a 6-month period (Aim 3). Knowing that not all patients will participate, we will consent a subgroup of the hospitalized older adults cared for by these caregivers (at least 40 dyads). If shown to be efficacious, our virtual health coaching intervention can easily scale to support millions of caregivers worldwide. This application addresses the NIA strategic plan and is in response to NOSI NOT-CA-22-037.