Toles awarded grant for Alzheimer’s and dementia care research

A middle-aged man with glasses and short, thinning hair smiles at the camera. He is wearing a light-colored, checkered button-up shirt. The background is blurred greenery. — *Mark Toles, PhD, RN, FAAN*

The UNC School of Nursing is proud to announce that Mark Toles, PhD, RN, FAAN and Laura Hanson, MD, MPH, from the UNC School of Medicine, have been awarded a R01 grant of $2,315,408 for their project titled, “Transitional Care for Skilled Nursing Facility Patients with Alzheimer’s Disease and Related Dementias and their Caregivers: a Cluster Randomized Trial.” The grant, which provides funding to start immediately, marks a significant milestone in advancing care for patients with Alzheimer’s disease and related dementias (ADRD) and their caregivers.

Every year, approximately 400,000 individuals with ADRD are hospitalized, transferred to skilled nursing facilities (SNFs), and subsequently transition to home, assisted living, or long-term care. Unfortunately, these transitions are often filled with challenges, as one in five patients are re-hospitalized within 30 days of discharge, and caregivers frequently experience high levels of strain and psychological distress. Notably, Black SNF patients and their caregivers face disproportionate challenges, including lower access to ADRD care and poorer outcomes following SNF discharge.

Drs. Toles and Hanson, recognizing these critical gaps in care, have designed the Connect-Home ADRD (C-H ADRD) transitional care intervention. This innovative approach adapts the successful Connect-Home transitional care model to specifically address the needs of ADRD patients and their caregivers. The intervention includes a comprehensive transition plan developed by SNF staff in collaboration with patient-caregiver dyads before discharge, followed by ongoing support from a Dementia Caregiving Specialist after discharge.

In preliminary studies, the C-H ADRD intervention demonstrated promising results, including reduced caregiver strain and fewer patient neuropsychiatric symptoms (NPS). With this new R01 grant, Drs. Toles and Hanson will conduct a cluster randomized trial (CRT) involving 360 ADRD patient and caregiver dyads across 12 SNFs to further evaluate the efficacy of the intervention.

The Specific Aims of the Project Include:

Conducting a CRT to compare caregiver outcomes, including strain, depression, and preparedness for care transitions, 30 days after discharge between the intervention and control groups.
Comparing patient outcomes such as NPS, quality of life, and acute care use between the intervention and control arms 30 days after discharge, while also exploring the potential for caregiver strain to modify patient outcomes.
Examining potential disparities in Connect-Home ADRD outcomes and implementation by race, identifying factors at the dyad-level and SNF-level that contribute to the fidelity of the C-H ADRD protocol.

The C-H ADRD intervention holds the potential to significantly improve health outcomes and promote health equity for individuals with ADRD and their caregivers, offering a path toward more effective and compassionate care transitions.