The dementia care study (D-CARE): Recruitment strategies and demographic characteristics of participants in a pragmatic randomized trial of dementia care.

INTRODUCTION: Pragmatic research studies that include diverse dyads of persons living with dementia (PLWD) and their family caregivers are rare. METHODS: Community-dwelling dyads were recruited for a pragmatic clinical trial evaluating three approaches to dementia care. Four clinical trial sites used shared and site-specific recruitment strategies to enroll health system patients. RESULTS: Electronic health record (EHR) queries of patients with a diagnosis of dementia and engagement of their clinicians were the main recruitment strategies. A total of 2176 dyads were enrolled, with 80% recruited after the onset of the pandemic. PLWD had a mean age of 80.6 years (SD 8.5), 58.4% were women, and 8.8% were Hispanic/Latino, and 11.9% were Black/African American. Caregivers were mostly children of the PLWD (46.5%) or spouses/partners (45.2%), 75.8% were women, 9.4% were Hispanic/Latino, and 11.6% were Black/African American. DISCUSSION: Health systems can successfully enroll diverse dyads in a pragmatic clinical trial.

The Macro Impact of Microtransitions in Post-acute and Long-Term Care.

The care transitions concept emerged in medical literature more than 40 years ago, with an exponential rise in publications dedicated to its exploration since that time. It is generally accepted that older patients are particularly vulnerable during care transitions because of complex medical comorbidity, frailty, cognitive dysfunction, and the fragmented nature of health care. A care transition is defined as the movement of patients from one health care setting to another as their care needs change during acute or chronic illness. Easily recognizable examples include the discharge of a patient from the hospital to a skilled nursing facility or an admission to the hospital after a patient is evaluated in the emergency department. These macrotransitions are marked by major changes in clinical condition and span days to weeks. This discussion examines a new term coined by the authors: microtransitions, which are care transitions characterized by movement of a patient between health care settings or within a given setting, usually over shorter periods (less than 24 hours) and accompanied by changes in clinical or custodial responsibility for a patient. Although often unrecognized as formal care transitions, these microtransitions, if not handled appropriately, can lead to poor outcomes, including clinical deterioration and the need for macrotransition. The authors propose formal recognition of microtransitions, standardization of processes related to them, and practical considerations for implementation.

Recruitment of older adult-caregiver dyads during the COVID-19 pandemic: an example from a study to evaluate a novel activities of daily living (ADL) sensor system.

Under ideal circumstances, recruitment of older adult-caregiver dyads to dementia research is challenging. The COVID-19 pandemic introduced additional barriers to recruitment, necessitating swift adjustments to pre-pandemic recruitment strategies and schedules. This brief research report describes the challenges, yield, and cost of recruiting older adult-caregiver dyads to an 18-month observational research study during COVID-19. The study aimed to evaluate the effectiveness of a novel in-home sensor system at identifying cognitive change in older adults with Alzheimer's disease and related dementias (ADRD) through background monitoring of activities of daily living (ADL). Recruitment methods included flyers distributed alongside home-delivered meals, direct mailings, publicly available brochures, community presentations, periodical advertisements, and various other strategies. Of 510 inquiries, 117 older adult-caregiver dyads were enrolled at a total cost of ~$368,000, yielding an average per dyad recruiting cost of $3,148. Distributing flyers alongside home-delivered meals produced the most dyads (n = 46, 39%) and the least non-labor costs ($24.33) per enrolled dyad. Recruitment during the pandemic exceeded the pre-COVID-19 budget, but enrollment goals were nevertheless achieved through community-based methods. Our experience illustrates the challenge of recruiting older adult-caregiver dyads to dementia research and the value of trusted community partners in recruiting this population. Our strategies and recommendations may benefit researchers who plan to recruit community-based older adults and their caregivers for future dementia research.