Bidirectional Associations of Awareness of Age-Related Change and Attitudes Towards Own Aging With Social Media Use.

OBJECTIVES: We test whether higher awareness of age-related gains (AARC-gains), lower awareness of age-related losses (AARC-losses), and more positive attitudes towards own aging (ATOA) are cross-sectionally related to more frequent social media use. We also investigate the strength and direction of the associations of AARC-gains, AARC-losses, and ATOA with social media use over one-year, from before to after the onset of the COVID-19 pandemic. METHODS: We used cross-sectional data of 8320 individuals (mean age= 65.95 years; SD= 7.01) and longitudinal data of a subsample of 4454 individuals participating to the UK PROTECT study in 2019 and 2020. We used ordered regression models, linear regression models, and tests of interaction. Models were adjusted for age, sex, education, and employment. RESULTS: Higher AARC-gains and more positive ATOA, but not AARC-losses, were cross-sectionally associated with more frequent social media use. Social media use become more frequent at follow-up. In the longitudinal models controlling for baseline levels of the outcome variable, more frequent baseline social media use predicted increases in AARC-gains, whereas baseline AARC-gains did not significantly predict frequency of social media use at follow-up. Baseline frequency of social media use did not significantly predict AARC-losses, nor ATOA at follow-up, whereas lower levels of AARC-losses and more positive ATOA predicted more frequent social media use at follow-up. DISCUSSION: Although effect sizes were small, decreasing negative views on aging may help increase engagement of middle-aged and older people with social media. At the same time, fostering social media use could promote positive self-perceptions of aging.

Antipsychotic prescriptions and neuropsychiatric symptoms (NPS) in nursing home (NH)residents with dementia: a comparison of pre‐ and during COVID pandemic

Background The COVID‐19 pandemic has put tremendous pressures on nursing homes, but there is limited direct data evaluating the impact on residents or prescribing practices Method As part of our clinical trial programme in nursing homes we have baseline data from 971 residents across 69 nursing homes collected in 2016/17 prior to the pandemic, and from 747 participants across 149 nursing homes from the baseline assessment of our COIVD WHELD RCT collected in 2021/22. In both studies the frequency if antipsychotic prescriptions was recorded and the Neuropsychiatric Inventory Nursing Home version was completed. Results The average age of residents (84.5 v 85.1) and gender balance (71%F v 69% F) was similar in both cohorts. In the current study 64% of participating nursing homes had experienced a COVID‐19 outbreak. There were fewer people with severe dementia in the COVID WHELD Cohort (6.7% v 23%). Antipsychotic usage was 55% higher in the COVID WHELD cohort compared to the original WHELD cohort (28% v 18%), with 25% of nursing homes having prescription rates >40%, but the rates of neuropsychiatric symptoms were similar in the 2 studies. To ensure that the results were not confounded by the lower number of people with severe dementia in the COVID WHELD cohort, a further comparison was undertaken for people with moderate/moderately severe dementia, with very similar results. We undertook an additional analysis comparing nursing homes above and below prescription rates of 20% (the pre‐COVID level of prescribing). Nursing homes with increased antipsychotic prescribing had significantly higher levels of overall neuropsychiatric symptoms on the NPI (p = 0.02), and significantly higher levels of agitation (p = 0.02) compared to nursing homes with lower prescribing rates. There were also 31% more staff sick days in the higher prescribing nursing homes. Conclusion There is a substantial increase in antipsychotic prescriptions in 50% of nursing homes since the onset of the COVID‐19 pandemic, associated in those nursing homes with an increase in neuropsychiatric symptoms. This will need to be a major focus as we begin to move forward from the pandemic.

Impact of the Covid-19 pandemic on neuropsychiatric symptoms and antipsychotic prescribing for people with dementia in nursing home settings.

OBJECTIVES: This study aimed to determine the impact of the Covid-19 pandemic on neuropsychiatric symptoms and antipsychotic use in people with dementia living in nursing homes. METHODS: This was a comparative analysis of baseline data from two large nursing home studies, one conducted during (COVID-iWHELD study) and one prior (WHELD study) to the pandemic. It involves data from 69 and 149 nursing homes, and 1006 and 666 participants respectively. Participants were people with established dementia (score >1 on Clinical Dementia Rating Scale). Resident data included demographics, antipsychotic prescriptions and neuropsychiatric symptoms using the Neuropsychiatric Inventory Nursing Home version. Nursing home data collected were nursing home size and staffing information. RESULTS: Overall prevalence of neuropsychiatric symptoms was unchanged from pre-pandemic prevalence. Mean antipsychotic use across the sample was 32.0%, increased from 18% pre-pandemic (Fisher's exact test p < 0.0001). At a nursing home level, the medians for the low, medium and high tertiles for antipsychotic use were 7%, 20% and 59% respectively, showing a disproportionate rise in tertile three. Residents in these homes also showed a small but significant increase in agitation. CONCLUSION: There has been a significant increase in antipsychotic prescribing in nursing homes since the COVID-19 pandemic, with a disproportionate rise in one third of homes, where median prescription rates for antipsychotics were almost 60%. Strategies are urgently needed to identify these nursing homes and introduce pro-active support to bring antipsychotic prescription rates back to pre-pandemic levels.

Healthcare utilisation, physical activity and mental health during COVID-19 lockdown: an interrupted time-series analysis of older adults in England.

COVID-19 measures which reduce interpersonal contact may be effective in containing the transmission, but their impacts on peoples' well-being and daily lives overtime remain unclear. Older adults are more vulnerable to both the virus and social isolation. It is therefore imperative to understand how they were affected during this period. Major concerns arising from the pandemic cover the aspects of mental health, healthcare utilisation and individual behavioural changes. Complementing the existing before-and-after analyses, we explore the impacts of easing and re-introducing COVID-19 measures by using a time-series data in England. The data was collected between May and November 2020 from the monthly surveys of the Platform for Research Online to Investigate Genetics and Cognition in Aging (PROTECT). Chi-squared analysis and interrupted time-series analysis were conducted to examine impacts of easing and re-introducing COVID-19 measures. Overall, mental health improves overtime but at a decreasing rate. The use of telephone/video consultations with a doctor or health professional presented a decreasing trend during the pandemic, whilst that of in-person consultation was increasing overtime. We observed significant variations in the time trends of mental health measures, healthcare utilisation and physical activity following the ease but not the re-introduction of COVID-19 measures. Future research is required to understand if these asymmetric impacts were driven by adaption of the people or stringency of the measures. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-022-00741-y.

Healthcare utilisation, physical activity and mental health during COVID-19 lockdown: an interrupted time-series analysis of older adults in England

COVID-19 measures which reduce interpersonal contact may be effective in containing the transmission, but their impacts on peoples’ well-being and daily lives overtime remain unclear. Older adults are more vulnerable to both the virus and social isolation. It is therefore imperative to understand how they were affected during this period. Major concerns arising from the pandemic cover the aspects of mental health, healthcare utilisation and individual behavioural changes. Complementing the existing before-and-after analyses, we explore the impacts of easing and re-introducing COVID-19 measures by using a time-series data in England. The data was collected between May and November 2020 from the monthly surveys of the Platform for Research Online to Investigate Genetics and Cognition in Aging (PROTECT). Chi-squared analysis and interrupted time-series analysis were conducted to examine impacts of easing and re-introducing COVID-19 measures. Overall, mental health improves overtime but at a decreasing rate. The use of telephone/video consultations with a doctor or health professional presented a decreasing trend during the pandemic, whilst that of in-person consultation was increasing overtime. We observed significant variations in the time trends of mental health measures, healthcare utilisation and physical activity following the ease but not the re-introduction of COVID-19 measures. Future research is required to understand if these asymmetric impacts were driven by adaption of the people or stringency of the measures. Supplementary Information The online version contains supplementary material available at 10.1007/s10433-022-00741-y.

The impact of the COVID‐19 pandemic on cognitive health

Background The COVID‐19 pandemic has presented an extraordinary and unprecedented challenge to individuals, society and governments. Aside from the direct clinical impacts of COVID‐19, the social restrictions are likely to have had considerable impacts on cognitive and mental health. Understanding these trends will be critical to improve future responses to outbreaks and to improve the treatment and care provided to individuals affected. Method PROTECT is an innovative online study (www.protect.org.uk) in adults aged 50 and over in the UK, Participants complete annual cognitive assessment and health measures including the PHQ‐9 and GAD‐7. Participants were divided into three cohorts (Normal Cognition, Stage 2 Early AD and Stage 3 Early AD, based on the FDA framework) using baseline data from the cognitive assessment battery. This analysis utilised data from a total of 5301 participants followed annually over the last 5 years, including the year of the COVID‐19 pandemic. It also utilises the newly published FLAME composite cognitive measure that has shown sensitivity to cognitive decline. Result In the participants with worsening PHQ‐9 and GAD‐7 scores between 2019 and 2020 (63%), composite measures of Speed [Stage 2: p=0.008, d=0.27;Stage 3: p=0.0006, d=0.17], and accuracy of Attention [Stage 2: p=0.004, d=0.11;Stage 3: p=0.0016, d=0.21], Memory [Stage 2: p=0.0011, d=0.3;Stage 3: p=0.0009, d=0.22] and Executive Function [p=0.08], as well as the composite FLAME measure [p=0.0014, d=0.28], showed a larger decline over the last 12 months compared to the prior assessment period. Whilst no significant increase in the rate of decline was seen in people without worsening of depression or anxiety. Conclusion The pandemic has had a detectable and significant detrimental impact on key aspects of cognitive health in adults over 50, including adults with early cognitive impairment (stage 2 and 3 pre‐clinical AD in the FDA framework) mediated predominantly through worsening of mental health.

Pandemic impact in care homes: Care homes perspectives

Background Care Homes (CH) are a vital resource in the health and social care system to support elderly people who may be unable to live at home independently. Older adults and carers have been disproportionately affected by coronavirus (COVID‐19). With 410 00 people living in CH, we lack data of how these major changes have impacted CH, and how CH are managing during the pandemic outbreak. We require knowledge, including what policies and procedures CH currently have;how they are mitigating risks;and how current experiences and guidance can improve care of CH residents during the current pandemic and future crises. Method CH members of the Care Home Research Network (CHRN) were invited to take part on an online anonymous survey. An email invitation was sent to 225 CH, with surveys completed between August to October 2020. The questionnaire comprised of 49 questions, focusing on CH details, their views of the impact on the CH, staff and residents, and questions exploring strategies, ideas, and guidelines that the CH followed. Result Fifty care homes completed the survey. With 60% of the CH having between 10‐40 beds, and 40% between 50 to more than 100 beds. 76% of the respondents felt that their institution had been affected by the pandemic, with 52% having residents dying due to COVID‐19 and 68% had staff absent due to COVID‐19. 94% of respondents felt an increased level of stress in their role due to COVID‐19, with 22% saying that they could not cope with the increase in the workload and 52% hiring staff to cope with the workload. 70% of respondents felt that residents were feeling lonelier and 56% that residents were more depressed. Conclusion CH have been greatly impacted by the Pandemic, with increased anxieties and stress in staff, they lacked the support and resources needed to better overcome the challenges caused by this Pandemic. Moreover, residents were lonelier and more depressed, and their family members were more anxious/worried, requiring more resources from CH to support residents and family members. CH had to adapt, be innovative, find new working ways and using technology to meet residents and family needs.

A Randomized Controlled Trial of a Digital Adaptation of the WHELD Person-Centered Nursing Home Training Program.

OBJECTIVE: Digital approaches to delivering person-centered care training to nursing home staff have the potential to enable widespread affordable implementation, but there is very limited evidence and no randomized controlled trials (RCTs) evaluating digital training in the nursing home setting. The objective was to evaluate a digital person-centered care training intervention in a robust RCT. DESIGN: We conducted a 2-month cluster RCT in 16 nursing homes in the United Kingdom, randomized equally to receive a digitally adapted version of the WHELD person-centered care home training program with virtual coaching compared to the digital training program alone. SETTING AND PARTICIPANTS: The study was conducted in UK nursing homes. There were 175 participants (45 nursing home staff and 130 residents with dementia). METHODS: The key outcomes were the well-being and quality of life (QoL) of residents with dementia and the attitudes and knowledge of nursing home staff. RESULTS: There were significant benefits in well-being (t = 2.76, P = .007) and engagement in positive activities (t = 2.34, P = .02) for residents with dementia and in attitudes (t = 3.49, P = .001), including hope (t = 2.62, P = .013) and personhood (t = 2.26, P = .029), for staff in the group receiving digital eWHELD with virtual coaching compared to the group receiving digital learning alone. There was no improvement in staff knowledge about dementia. CONCLUSION AND IMPLICATIONS: The study provides encouraging initial clinical trial evidence that a digital version of the WHELD program supported by virtual coaching confers significant benefits for care staff and residents with dementia. Evidence-based digital interventions with remote coaching may also have particular utility in supporting institutional recovery of nursing homes from the COVID-19 pandemic.

Clinical experience with polygenic risk score in subjects with early cognitive concerns.

BACKGROUND: There is mounting evidence that lifestyle interventions and behavioural changes play a significant role in maintaining cognition and function, as well as preventing dementia. Consequently, it is important that clinicians confronted with subjects with early cognitive concerns, have appropriate tools available to assist in diagnosis and to facilitate risks management appropriately. The application of polygenic risk score (PRS) tests has the potential to contribute towards management planning and to reduce the burden of testing in subjects with low overall risk. METHODS: This retrospective analysis considered the application of genoSCORETM in a small cohort of patients seen over a six month period in a London Memory Clinic. The test was offered to selected patients in the clinic with MCI not clinically attributable to dementia, or cognitively normal individuals concerned about their risks of dementia. The impact upon clinical management and lifestyle modification was reviewed. genoSCORE, a polygenic risk score algorithm, was developed by Cytox to assess genetic risk for the future development of Late-Onset Alzheimer's disease (LOAD). RESULTS: Patients receiving the genoSCORE test included those with early MCI, subjective memory complaints and a small number concerned about their risk of dementia. In each case, a medical history was taken and individuals assessed using the Addenbrooke's Cognitive Examination, conducted either in clinic or remotely. genoSCORE polygenic risk score was easy to conduct and well received. The results stimulated individuals at risk of developing LOAD to make lifestyle adjustments and thereby potentially modifying their dementia risk. CONCLUSIONS: In this study, the genoSCORE PRS test provided a valuable assessment of genetic risk of individuals most likely to decline cognitively decline towards AD and as such, contributed significantly to clinical management decisions. The ease and effectiveness of home sampling of saliva as source DNA for the PRS test was a major factor and well aligned with the continuing need for remote consultations in the light of COVID-19 concerns. Further larger-scale studies to determine the full clinical and associated economic impact of the genoSCORE PRS test are required.

COVID-19 and vaccination programme in one residential home

Background Approximately 410 000 people live in care homes (CH) or residential settings in the UK, with the majority of this population being above the age of 85, making this group fall in the category of higher risk of more severe COVID-19 symptoms and death. CH have been disproportionately affected by COVID-19, people living and working in these settings have a higher risk of exposure to infection and higher risk of severe disease and mortality. CH residents and staff were prioritised for the vaccination programme in the UK due to increased risk of outbreaks, morbidity and mortality. Method One Residential home reported a COVID-19 outbreak following the vaccination programme. Most staff vaccinated between 16-18 December 2020, and most residents vaccinated on 30/12/2020. Residents were on isolation from 22/12/2020 prior to vaccination. The first positive COVID-19 case was on 27th December. Staff and residents were scored according to the World Health Organisation (WHO) Ordinal Scale for Clinical Improvement (OSCI), table 1. Result Of staff vaccinated, 20,83% (n=5) tested positive for COVID-19. Nine staff members (27.28%) didn't have the vaccine, with 7 of these (77.78%) developing more limiting symptoms (OSCI score 2), compared to 8.33% (n=2) of those who had the vaccine. With 100% of residents vaccinated, 21 residents (65,63%) developed COVID-19 symptoms, and 31.25% (n=10) developing more limiting COVID-19 symptoms or death. Nineteen residents have a diagnosis of dementia and 63.16% (n=12) developed COVID-19 symptoms and 50% (n=6) of those with dementia died, whilst those without dementia did not have any deaths reported. Conclusion Although this reflects the experience of a single CH, it is of relevance in suggesting substantial protection for staff who have been vaccinated, even though there was only 11 days between vaccination and the start of the outbreak. The experience in this CH starkly emphasizes the poor outcomes of COVID-19 for residents, especially those with dementia, and unfortunately suggests that there are no benefits from vaccination as a secondary prevention approach once an outbreak has started. Ongoing evaluation will be important to optimize the delivery of the vaccination programme in CH settings, and to optimize staff take up of the vaccine.

Healthcare utilisation and physical activities for older adults with comorbidities in the UK during COVID-19.

A major concern with COVID-19 was the impact it would have on individual health, the routine use of healthcare services, and physical activities, especially for older adults with comorbidities. To address this, we studied the association between these variables for older adults during the pandemic. To explore what policy instruments might be effective in mitigating the negative impacts, we investigated the effects of a shielding notice for those identified as vulnerable by the government and social media given it has been an important source for disseminating information of COVID-19. We employed a UK sample with 3,807 participants aged ≥50 from an online survey administered during May and June 2020. Based on numbers of comorbidities, we separated the sample into a higher comorbidity group with those in the upper quartile of the sample (n = 829) and a lower comorbidity group with the remainder (n = 2,978). Statistical methods include chi-squared analyses and cross-sectional regressions. We found that individuals with higher comorbidities were more likely to have poorer self-reported health and mental health and to receive a shielding notice from the government compared to those without (p < 0.05). Decreases in physical activities were associated with poorer self-reported health and the increases were associated with better self-reported health; on the other hand, the decreases were associated with poorer mental health, but the increases did not link to better mental health. Examination of the effects of policy instruments shows that a shielding notice was positively associated with primary care use. The notice generated greater reliance on telephone/video consultations compared to in-person consultations, but the impacts were less strong for people with higher comorbidities. Frequent use of social media raised the probability of increasing physical activities and reduced that of decreasing physical activities, implying social media being an effective tool in promoting physical activities during the lockdown and subsequent restrictions.

Loneliness, physical activity, and mental health during COVID-19: a longitudinal analysis of depression and anxiety in adults over the age of 50 between 2015 and 2020.

OBJECTIVE: Loneliness and physical activity are important targets for research into the impact of COVID-19 because they have established links with mental health, could be exacerbated by social distancing policies, and are potentially modifiable. In this study, we aimed to identify whether loneliness and physical activity were associated with worse mental health during a period of mandatory social distancing in the UK. DESIGN: Population-based observational cohort study. SETTING: Mental health data collected online during COVID-19 from an existing sample of adults aged 50 and over taking part in a longitudinal study of aging. All had comparable annual data collected between 2015 and 2019. PARTICIPANTS: Three-thousand two-hundred and eighty-one participants aged 50 and over. MEASUREMENTS: Trajectories of depression (measured by PHQ-9) and anxiety (measured by GAD-7) between 2015 and 2020 were analyzed with respect to loneliness, physical activity levels, and a number of socioeconomic and demographic characteristics using zero-inflated negative binomial regression. RESULTS: In 2020, PHQ-9 score for loneliness, adjusted for covariates, was 3.23 (95% CI: 3.01-3.44), an increase of around 1 point on all previous years in this group and 2 points higher than people not rated lonely, whose score did not change in 2020 (1.22, 95% CI: 1.12-1.32). PHQ-9 was 2.60 (95% CI: 2.43-2.78) in people with decreased physical activity, an increase of .5 on previous years. In contrast, PHQ-9 in 2020 for people whose physical activity had not decreased was 1.66, 95% CI: 1.56-1.75, similar to previous years. A similar relationship was observed for GAD-7 though the absolute burden of symptoms lower. CONCLUSION: After accounting for pre-COVID-19 trends, we show that experiencing loneliness and decreased physical activity are risk factors for worsening mental health during the pandemic. Our findings highlight the need to examine policies which target these potentially modifiable risk factors.

A Preliminary Investigation of the Views of People With Parkinson's (With and Without Psychosis) and Caregivers on Participating in Clinical Trials During the Covid-19 Pandemic: An Online Survey.

Background: The coronavirus pandemic is having a profound impact on non-COVID-19 related research, including the delivery of clinical trials for patients with Parkinson's disease. Objectives: A preliminary investigation to explore the views of Parkinson's disease (PD) patients, with and without experience of psychosis symptoms, and carers on the resumption of clinical research and adaptations to trials in light of COVID-19. Methods: An anonymous self-administered online survey was completed by 30 PD patients and six family members/carers via the Parkinson's UK Research Support Network to explore current perceptions on taking part in PD research and how a planned clinical trial for psychosis in PD may be adapted so participants feel safe. Results: Ninety-one percent of respondents were enthusiastic about the continuation of non-COVID-19 related research as long as certain safety measures were in place. Ninety-four percent stated that they would be happy to complete assessments virtually. However, they noted that care should be taken to ensure that this does not exclude participants, particularly those with more advanced PD who may require assistance using portable electronic devices. Regular and supportive communication from the research team was also seen as important for maintaining the psychological well-being of participants while taking part in the trial. Conclusions: In the era of COVID-19 pandemic, standard approaches will have to be modified and rapid adoption of virtual assessments will be critical for the continuation of clinical research. It is important that alongside the traditional methods, new tools are developed, and older ones validated for virtual assessments, to allow safe and comprehensive assessments vital for ongoing research in people with Parkinson's.

Implementing Remote Memory Clinics to Enhance Clinical Care During and After COVID-19.

Social isolation is likely to be recommended for older adults due to COVID-19, with ongoing reduced clinical contact suggested for this population. This has increased the need for remote memory clinics, we therefore review the literature, current practices and guidelines on organizing such remote memory clinics, focusing on assessment of cognition, function and other relevant measurements, proposing a novel pathway based on three levels of complexity: simple telephone or video-based interviews and testing using available tests (Level 1), digitized and validated methods based on standard pen-and-paper tests and scales (Level 2), and finally fully digitized cognitive batteries and remote measurement technologies (RMTs, Level 3). Pros and cons of these strategies are discussed. Remotely collected data negates the need for frail patients or carers to commute to clinic and offers valuable insights into progression over time, as well as treatment responses to therapeutic interventions, providing a more realistic and contextualized environment for data-collection. Notwithstanding several challenges related to internet access, computer skills, limited evidence base and regulatory and data protection issues, digital biomarkers collected remotely have significant potential for diagnosis and symptom management in older adults and we propose a framework and pathway for how technologies can be implemented to support remote memory clinics. These platforms are also well-placed for administration of digital cognitive training and other interventions. The individual, societal and public/private costs of COVID-19 are high and will continue to rise for some time but the challenges the pandemic has placed on memory services also provides an opportunity to embrace novel approaches. Remote memory clinics' financial, logistical, clinical and practical benefits have been highlighted by COVID-19, supporting their use to not only be maintained when social distancing legislation is lifted but to be devoted extra resources and attention to fully potentiate this valuable arm of clinical assessment and care.

Transcription-based drug repurposing for COVID-19.

We have utilised the transcriptional response of lung epithelial cells following infection by the original Severe Acute Respiratory Syndrome coronavirus (SARS) to identify repurposable drugs for COVID-19. Drugs best able to recapitulate the infection profile are highly enriched for antiviral activity. Nine of these have been tested against SARS-2 and found to potently antagonise SARS-2 infection/replication, with a number now being considered for clinical trials. It is hoped that this approach may serve to broaden the spectrum of approved drugs that should be further assessed as potential anti-COVID-19 agents and may help elucidate how this seemingly disparate collection of drugs are able to inhibit SARS-2 infection/replication.

LIVE@Home.Path-innovating the clinical pathway for home-dwelling people with dementia and their caregivers: study protocol for a mixed-method, stepped-wedge, randomized controlled trial.

BACKGROUND: The global health challenge of dementia is exceptional in size, cost and impact. It is the only top ten cause of death that cannot be prevented, cured or substantially slowed, leaving disease management, caregiver support and service innovation as the main targets for reduction of disease burden. Institutionalization of persons with dementia is common in western countries, despite patients preferring to live longer at home, supported by caregivers. Such complex health challenges warrant multicomponent interventions thoroughly implemented in daily clinical practice. This article describes the rationale, development, feasibility testing and implementation process of the LIVE@Home.Path trial. METHODS: The LIVE@Home.Path trial is a 2-year, multicenter, mixed-method, stepped-wedge randomized controlled trial, aiming to include 315 dyads of home-dwelling people with dementia and their caregivers, recruited from 3 municipalities in Norway. The stepped-wedge randomization implies that all dyads receive the intervention, but the timing is determined by randomization. The control group constitutes the dyads waiting for the intervention. The multicomponent intervention was developed in collaboration with user-representatives, researchers and stakeholders to meet the requirements from the national Dementia Plan 2020. During the 6-month intervention period, the participants will be allocated to a municipal coordinator, the core feature of the intervention, responsible for regular contact with the dyads to facilitate L: Learning, I: Innovation, V: Volunteering and E: Empowerment (LIVE). The primary outcome is resource utilization. This is measured by the Resource Utilization in Dementia (RUD) instrument and the Relative Stress Scale (RSS), reflecting that resource utilization is more than the actual time required for caring but also how burdensome the task is experienced by the caregiver. DISCUSSION: We expect the implementation of LIVE to lead to a pathway for dementia treatment and care which is cost-effective, compared to treatment as usual, and will support high-quality independent living, at home. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04043364. Registered on 15 March 2019.