Improving self-care of caregivers of adults in homecare with heart failure and cognitive impairment - cognitive impairment (CI) has been reported to be as high as 78% in older adults with heart…

The National Institute on Aging awarded Visiting Nurse Service of New York $1,271,742 on September 15, 2025, under the Aging Research program (CFDA 93.866) to conduct a Stage II trial expanding the Virtual Caregiver Coach for You (ViCCY) intervention to caregivers of home health care patients with concurrent heart failure and cognitive impairment.

The project enrolls 254 caregivers supporting patients with heart failure and cognitive impairment from home health care in New York City, plus at least 60 patients with mild or moderate cognitive impairment (30 per study arm). ViCCY is a 10-session virtual health coaching intervention designed to increase caregiver self-care and decrease stress. The prior efficacy trial demonstrated success in improving self-care and reducing stress among 250 caregivers, though that sample was predominantly White (62.2%), female (85.2%), and financially secure (82.3%), with patients having few comorbid conditions and only 10 percent with mild cognitive impairment. This expanded trial deliberately recruits from an underserved, diverse population of caregivers with poor self-care and poor mental health outcomes.

Performance occurs in New York, New York, with a period of performance through August 31, 2030.

The University of Pennsylvania School of Nursing serves as a sub-recipient. Dr. Karen Hirschman commits 8 percent effort and participates in all study-related meetings, health coach interviewing and training, intervention fidelity monitoring via twice-monthly meetings with health coaches, and data management. The sub-award was dated October 13, 2025.

Improving self-care of caregivers of adults in homecare with heart failure and cognitive impairment - cognitive impairment (CI) has been reported to be as high as 78% in older adults with heart failure (HF). Patients with both HF and CI are rarely able to manage without a caregiver. The demands of caregiving for someone with HF/CI are high and cause stress in caregivers and strain in the relationship, which leads to negative social exchanges, poor coping, and lower mental health in caregivers. Anxiety, depression, and somatic symptoms are common in patients with HF and relationship strain can make these symptoms worse. Support interventions can decrease stress in caregivers. We demonstrated efficacy of a 10-session virtual health coaching intervention, virtual caregiver coach for you (viccy), for caregivers of adults with HF (R01-NR-018196) that focused on increasing caregiver self-care. Viccy was successful in improving self-care and decreasing stress in a sample of 250 caregivers recruited from a large urban regional referral center for advanced HF care. However, the caregivers were primarily white (62.2%) women (85.2%) with adequate financial resources (82.3%) and the patients were principally men with few comorbid conditions; only 10% had mild CI. Now that we have shown efficacy in this first stage II trial, we aim to expand testing to a broader, more challenging population of underserved caregivers of patients with HF/CI. In the proposed trial we will enroll 254 caregivers supporting patients with HF/CI from home health care (HHC). We will also enroll at least 60 patients with HF and mild or moderate CI (30/study arm). In new york city, where this study will be conducted, many of the patients referred to HHC are older adults from wide-ranging populations with a variety of chronic conditions including HF/CI. We will enroll caregivers of older HHC patients with HF/CI with poor self-care and poor mental health, purposefully seeking a varied sample. Using a stage II randomized controlled trial (RCT) design, we will randomize caregivers 1:1 to viccy or a usual care (UC) control group. At baseline, 3, 6, and 12 months, we will collect self-reported data from caregivers and patients to assess intervention efficacy and sustainability using intent-to-treat analysis. Having demonstrated that viccy improves mechanistic outcomes at 6-months in the first RCT, here we will focus on mental health as the primary outcome in caregivers. Enrolling patients will allow US to explore whether an intervention for caregivers can improve outcomes in patients. Mechanistic analyses will be used to explore which kinds of changes in caregivers translate into changes in patients. Specific aims are to test the efficacy of viccy VS. UC in improving outcomes of caregivers of HHC patients with HF/CI, explore the effect of viccy on outcomes in HHC patients with HF/CI, and describe the mechanisms by which outcomes are achieved. This application aligns with NIA's notice of special interest on behavioral and social science priority areas in dementia care partner/caregiver research (not-AG-21-047). If viccy is efficacious in caregivers assisting HHC patients with HF/CI, this will be further evidence that viccy may be able to address a need for support for millions of caregivers worldwide.