Behavioral Shifts in Dementia Patients Using Novel Pharmacy Home Robotics: A Cost-Effective Approach to Aging in Place

Project Summary Over 7 million Americans aged 65 and older are living with Dementia, making it a leading cause of dependence and disability. Alzheimer's Disease and Alzheimer's Disease Related Dementias (AD/ADRD) remain a public health crisis stemming from behavioral and psychological symptoms that have to be managed directly by caregivers. Patients with AD/ADRD ($287,038) are the most expensive chronic conditions to manage, with costs often exceeding those of cancer ($173,383) or heart disease ($175,136). Poor medication adherence contributes to high rates of hospitalizations, caregiver burden, and significant reductions in one's quality of life (QoL). The home environment standard of care for caregivers varies greatly; currently, medication management devices are contra-indicated for AD/ADRD use. Current medication adherence rates for AD/ADRD are estimated to be ~17-42%, and medication behaviors remain challenging to track. HiDO Tech developed HomeCare, an internet-connected self-medicating device integrated with a novel Pharmacy Distribution System (PDS) to address these gaps. The PDS ensures a secure chain of custody for medications, from delivery by a licensed mail-order pharmacy to administration by HomeCare, which uses Video Direct Observed Therapy (VDOT) to monitor consumption and alert caregivers to deviations. In a phase I SBIR R43AG077737, HiDO Tech demonstrated the feasibility and usability of HomeCare with AD/ADRD, and in a Medicare Advantage pilot study, HomeCare successfully altered patient medication behaviors, improving QoL, which decreased hospitalizations by 80% and lowered the cost of care by 67%. In Phase II, HiDO Tech will conduct a two-arm randomized controlled trial to validate the HomeCare and PDS system's ability to improve adherence, cognitive outcomes, and caregiver support for persons with Dementia (PwD). Primary Outcomes: Medication adherence will be tracked through automated logs in the HomeCare arm and self-reported logs in the standard care arm. Cognitive function will be assessed using the ECog at baseline, six months, and 12 months. Hospitalization rates will be measured quarterly via EMR reviews. Secondary Outcomes: Caregiver burden will be evaluated through task logs and surveys, while satisfaction and usability will be assessed using standardized metrics like NPS. Correlations between adherence improvements and reduced hospitalizations will also be analyzed. Exploratory Outcomes: QoL for patients and caregivers will be measured using DEMQOL and Zarit Burden tools. Caregiver-patient engagement will be explored through interviews, surveys, and activity logs. Impact: HomeCare with integrated PDS offers a transformative solution for AD/ADRD care by reducing hospitalizations, stabilizing chronic conditions, improving QoL, and alleviating caregiver burden. This low-cost device bridges critical gaps in dementia care, driving innovation and cost-effectiveness.