Low‐Intensity Social Care for Dementia Caregivers: A Randomized Trial

BACKGROUND: Resource needs increase strain among dementia caregivers. We tested the impact of CommunityRx-Dementia, a low-intensity resource referral intervention that provides education about common resource needs, a personalized list of nearby resources, and navigation support via a navigator and online resource finder. METHODS: We conducted a single-blind RCT comparing usual care (control) versus usual care plus CommunityRx-Dementia (intervention). We enrolled (12/2020-2/2024) English-speaking dementia caregivers agreeing to receive text messages who lived in a 62 ZIP code geography around an urban academic medical center. We assessed caregiver self-efficacy (primary, 12 months), loneliness, need for help and self-reported hospitalizations and emergency department (ED) visits (other pre-specified outcomes). Pre-planned, main analyses included participants with ≥ 1 baseline health-related social risk (HRSRs); post hoc analyses included caregivers without baseline HRSRs. RESULTS: Caregivers with HRSRs (n = 133) were predominantly female (84%) and Black (79%); 52% had household income < $50 K/year; 94% texted a navigator and 31% requested additional resource information. Caregiver self-efficacy (range 1-5, intervention = 3.5; control = 3.5, odds ratio [OR]: 0.80, 95% CI: 0.30, 2.09) and rates of loneliness (intervention = 41%; control = 50%; OR: 0.62, 95% CI: 0.24, 1.59), needing help (23% = intervention, 34% = control; OR: 0.80, 95% CI: 0.30, 2.11) and hospitalization (intervention = 0.1, control = 0.2; IRR: 0.42, 95% CI: 0.14, 1.30) were similar at 12 months, but ED utilization was lower in the intervention group (0.3 vs. 0.7, IRR: 0.41, 95% CI: 0.19, 0.90). Caregivers without HRSRs (n = 210) were mainly female (75%) and Black (82%); 25% had household income < $50 K/year; 95% texted a navigator and 39% requested additional resource information. Self-efficacy, loneliness, hospitalizations, and ED utilization were similar between arms at 12 months, but odds of needing help were 0.31 (95% CI: 0.12, 0.83) for the intervention group. CONCLUSIONS: A low-intensity social care intervention aimed at dementia caregivers did not improve self-efficacy at 12 months but reduced emergency care utilization among those with HRSRs. TRIAL REGISTRATION: ClinicalTrials.gov, Registered 10/29/19, Identifier: NCT04146545.