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Informal caregivers perform complex home-care tasks but often lack structured training, causing preventable safety risks and burden. Technology-enhanced simulation provides practice; psychoeducational programs that flag risky activities may strengthen safety behaviors and self-efficacy. Comparing costs guides scalable caregiver training. This study compared the cost-consequences of traditional and immersive digital simulation for home care, focusing on costs, errors avoided, and caregiver-burden reduction. This is a prospective observational comparative cohort study with secondary cost-consequence analysis and incremental cost-effectiveness ratios (ICERs) versus control, expressed in €/error avoided and €/burden point reduced. Costs are reported in euros. A prespecified synthesis of 3 coordinated studies yielded 3 active arms plus a control cohort, implemented independently between August 2023 and July 2025 under a shared core protocol in comparable Spanish home-care settings. Arms were psychoeducation, virtual reality (VR), 360° video training (360VT), and standard education as control. Outcomes were 3-month changes in self-reported errors and caregiver burden, measured with the Zarit Burden Interview-7 (ZBI-7; 0-28). Costing adopted a societal perspective and included staff time, caregiver time, and development costs amortized over 3 years at 200 participants/year. Downstream health care use was modeled by applying 1%-5% of follow-up incidents (base case 2%) to a €1,257 composite unit cost. Combined costs equaled direct plus downstream costs, with no discounting over 3 months. Costs and consequences were reported in natural units, including incremental and pairwise comparisons. A total of 282 caregivers were included (psychoeducational n=71, VR n=70, 360VT n=71, and control n=70). Incident changes over a 3-month period were: +0.44 (95% CI 0.06 to 0.82) for control, -0.51 (95% CI -0.89 to -0.13) for psychoeducational, -0.56 (95% CI -0.97 to -0.20) for VR, and -0.20 (95% CI -0.66 to 0.09) for 360VT. Combined cost/per participant (direct +2% downstream) was: €46.88 for control, €77.04 for psychoeducational, €105.60 for VR, and €42.97 for 360VT. ICERs versus control were: (1) for errors avoided, -€31.75/error (95% CI €19.78 to -€54.98) for psychoeducation, €58.72/error (95% CI €39.40 to -€97.89) for VR, and 360VT was dominant, saving €6.11 (95% CI €4.24 to -€10.63) per error avoided, with €3.91 (95% CI €3.52 to -€4.29) saved per participant; (2) for burden reduced (ZBI-7), -€55.85/point (95% CI €38.27 to -€98.68) for psychoeducational, €45.88/point (95% CI €32.12 to -€76.67) for VR, and 360VT was dominant, saving €6.41 (95% CI €4.42 to -€11.23) per point reduced, with €3.91 (95% CI €3.52 to -€4.29) saved per participant. Pairwise for burden were as follows: (1) VR versus psychoeducational, €38.59 (95% CI €26.89 to -€66.13) per extra point; (2) 360VT versus psychoeducational dominant; and (3) VR versus 360VT, €93.48 (95% CI €64.41 to -€163.85) per extra point. This real-world cost-consequence analysis innovatively compares immersive and nonimmersive training for informal caregivers from a societal perspective, using harmonized safety, burden, and downstream cost outcomes. Findings support stepped adoption: 360VT as a scalable default, VR for higher-risk tasks or caregivers with greater burden, and psychoeducation as a complementary low-cost strategy when resources are constrained.

Informal carers, people providing unpaid support to relatives or close others with an illness, disability, or advanced age-related care needs, are key stakeholders in health care systems. Carers have their own health and well-being challenges; however, their needs and care pathways are often overlooked by health care providers. Open online courses offer opportunities to address the information and support needs of large numbers of carers. However, our collective understanding of the design and outcomes of courses and learner experiences is limited. This systematic integrative review aimed to map the characteristics of open online courses for informal carers, explore learner experiences, and identify barriers and enablers to participation to inform the design of future courses. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we systematically searched 4 electronic databases (APA PsycINFO, CINAHL, EMBASE, and MEDLINE) for papers published from inception to January 30, 2025. Included papers were peer-reviewed, in the English language, and reported on the development, delivery, or outcomes of open online courses for informal carers aged more than 16 years. Excluded papers had no carer focus or were conference abstracts. Two reviewers independently screened titles and abstracts for eligibility. Backward and forward citation searches were conducted. Due to study heterogeneity, data on paper methodology, course characteristics, and course evaluations were extracted and synthesized narratively. Quality assessments of quantitative papers and the quantitative components of mixed methods papers used the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. Qualitative components within mixed methods papers were appraised using the Critical Appraisal Skills Program (CASP) toolkit. Searches identified 201 papers, of which 10 (6 quantitative and 4 mixed methods) met the inclusion criteria. No qualitative papers were identified. All included courses were massive open online courses. Sample sizes ranged from 3 to 17,591 participants, primarily targeting carers of older individuals (n=4). Completion rates ranged from 42% to 67% (n=5). Five papers reported improved carer knowledge and application of skills. Key enablers to learning included course accessibility and flexibility. Key barriers to learning included limited peer interaction, technical difficulties, time constraints, language challenges, and online privacy challenges. Most papers were of weak quality, except for 1 strong quantitative RCT. The evidence was limited by moderate-to-weak study quality, inconsistent measures, and exclusion of gray literature. Despite these limitations, findings suggest that open online courses may improve carers' knowledge and skills and enable accessible, flexible learning. However, barriers to learning, including limited learner-to-learner interaction within and external to the course, time constraints, and digital or language barriers, highlight the need for more inclusive and interactive course designs. Further high-quality research is needed to standardize outcomes.

Most people living with dementia experience behavioral and psychological symptoms of dementia (BPSD), leading to poor quality of life and hospitalizations and causing a significant burden for informal caregivers and health care systems, with a global lack of equitable support to manage these symptoms in the community. Telephone interventions can potentially improve the accessibility and flexibility of long-term dementia support. This systematic review evaluates the effectiveness of telephone interventions in managing BPSD for community-dwelling patients with dementia and their informal caregivers, and thereby reducing BPSD-related hospitalizations. A systematic search of 4 databases (MEDLINE, Embase, PsycInfo, and SCOPUS) was conducted. The authors included studies with telephone interventions with no blended component (ie, other technologies or in-person portion) and outcomes assessing the impact of these interventions on people with dementia, informal caregivers, and hospitalizations using quantitative measures. The risk of bias of the studies was measured using the National Heart, Lung, and Blood Institute assessment tools. Findings were analyzed applying a thematic synthesis approach. Of 4355 studies screened in 2024, 12 met the inclusion criteria. Studies were conducted in 5 high-income countries, and the majority were randomized controlled trials, with 2 non-randomized controlled trials and 2 pre-post intervention studies. Interventions included telephone coaching calls, psychosocial and educational support calls, and online platforms. Most studies showed a reduction in BPSD and BPSD-related burden; however, the certainty of this evidence was rated as low according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) analysis. In total, 9 studies reported reduced BPSD, and 5 studies showed a statistically significant decrease, while 4 studies indicated significant improvements in BPSD-related caregiver burden. One study considered BPSD-related hospital admissions, reporting a statistically significant reduction in admission rates. Telephone interventions delivered through psychosocial and educational calls and online platforms are promising tools for reducing BPSD-related caregiver burden. Personalized telephone interventions, including patients and informal caregivers in the treatment plan, may improve behavioral and psychological symptoms in patients with dementia. However, the certainty of evidence for both outcomes was low; therefore, these findings should be interpreted with caution. To strengthen the evidence base and assess the global applicability of such interventions, high-quality studies-particularly in low- and middle-income countries-are needed. Future research should incorporate longer follow-up periods, cost-effectiveness analyses, and greater consistency in intervention design and outcome measurement to better inform clinical practice and policy.

Latino caregivers of persons living with dementia face distinct financial challenges, spending nearly half of their annual household income on caregiving expenses, almost twice as much as non-Latino caregivers. Cultural norms, limited access to financial resources, and underrepresentation in intervention research compound this economic burden. There remains a critical gap in evidence-based, culturally tailored programs designed to reduce financial stress among Latino caregivers. This study examines the acceptability and perceived value of the Confidently Navigating Financial Decisions and Enhancing Financial Well-Being in Dementia Caregiving (CONFIDENCE) program, a culturally tailored, web-based psychoeducational intervention designed to reduce financial stress and improve financial well-being among Latino caregivers of persons living with dementia. We applied a multimethod approach to evaluate the acceptability of the CONFIDENCE pilot. Following completion, 14 caregivers participated in in-depth, semistructured interviews, and 27 (39% of program participants) completed a 14-item satisfaction survey. The study was guided by a theoretical framework of acceptability composed of 7 domains: affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy. Interview transcripts were analyzed independently by 4 coders (SM, RAR, DS, and KM) using thematic analysis, and survey responses were summarized using descriptive statistics. Participants overall reported satisfaction with the CONFIDENCE program. Qualitative analysis of interview transcripts revealed four themes: (1) the perceived need for financial intervention; (2) perceived intervention effectiveness, particularly in improving financial knowledge, communication skills, and mental health; (3) positive emotional responses to participation, with high praise for the program's group setting and cultural relevance; and (4) recommendations for intervention improvement, including shorter sessions and technology support. Survey results confirmed high acceptability, with 96% (n=26) of respondents reporting they enjoyed the program. All participants (n=27, 100%) said they would recommend CONFIDENCE to other Latino caregivers. Participants reported improved awareness of available resources, increased confidence in financial decision-making, and reduced financial stress. Caregivers appreciated the group setting, which allowed for mutual interaction and learning; discussions fostered emotional connection and peer learning. Participants praised the content's trustworthiness and relevance. Although most agreed that participation required minimal effort, barriers such as time constraints and technology challenges were noted. Findings suggest that CONFIDENCE is acceptable among Latino caregivers of persons living with dementia. Culturally tailored content, group learning, and an emphasis on practical financial strategies were central to the program's success. Findings will inform program refinements, including limiting burden by addressing barriers while maintaining strengths such as group learning to optimize engagement. Considering the unique economic burdens Latino caregivers face, it is vital to develop and support interventions tailored to their unique needs. This study adds to the limited but growing literature on financial well-being interventions for Latino caregivers and highlights the value of culturally informed, community-driven approaches to supporting caregiver financial resilience.

Providing informal care to people with dementia living at home can be challenging and may cause caregiver stress and depression. Interventions delivered through mobile apps provide innovative solutions for community-based social care professionals to address the increasing support needs of family caregivers (FCs) of people with dementia. This study aimed to examine, among FCs of people with dementia living at home, (1) the potential association between professional support provided through a mobile app and caregiver stress and depressive symptoms, (2) types of support provided through chat interactions between FCs and social care professionals, and (3) how support provided through a mobile app relates to changes in caregiver stress and depressive symptoms. A mixed methods pilot study integrated quantitative pre- and postintervention data with qualitative logged chat data. FCs of people with dementia living at home (n=35) were recruited to test a tailor-made mobile app over 8 weeks. The primary and secondary outcome measures were caregiver stress and depressive symptoms, respectively. Descriptive statistics were used to summarize sociodemographic factors; inferential statistics were used to analyze mean differences in outcomes pre- and postintervention. FCs were divided into 3 groups based on changes in caregiver stress scores between pre- and postintervention. Generalized linear model analyses determined the association between participation in the intervention and caregiver stress and depressive symptoms, adjusting for age, gender, and relationship to the person with dementia. Logged chat data were analyzed using summative content analysis to identify types of support provided and received. Changes in caregiver stress were integrated with chat data to determine patterns in types of support received. The mean age of FCs was 69.4 (SD 11.9) years, with most being women (28/35, 80%), partners (24/35, 68.6%), and living with the person with dementia (26/35, 74%). The mean score of caregiver stress was marginally higher postintervention (24.1, SD 9.3) than preintervention (23.9, SD 9.2), whereas the mean score of depressive symptoms decreased from pre- (6.5, SD 5.1) to postintervention (6.2, SD 5.2). These differences were not statistically significant. Regression analyses showed that participation in the intervention was not statistically significantly associated with caregiver stress (β=0.171, α=.05; P=.86) or depressive symptoms (β=-0.293, α=.05; P=.75) after adjusting for age, gender, and relationship to the person with dementia. However, mixed methods analysis at the subgroup level suggested that frequent tailored support by social care professionals delivered through a mobile app may reduce caregiver stress among FCs of people with dementia living at home. The study highlights the importance of providing frequent and individualized support to meet the needs of FCs of people with dementia. Findings from this study may help community-based social care providers plan and organize digital support content provided to FCs of people with dementia living at home.

Dementia caregivers often want to support aging at home, but as neuropsychiatric symptoms (NPS) become more severe, caregiver challenges increase, often resulting in negative outcomes for both the caregiver and care recipient and institutionalization. Project CARE is a manualized in-person group intervention for dementia caregivers designed to reduce negative caregiver outcomes by teaching skills to manage NPS in care recipients in the home environment. Interventions that occur in person, however, can be difficult for caregivers to attend. Telehealth-based interventions are possible alternatives that reduce barriers to attendance. The primary objective of this pilot study was to evaluate the feasibility and acceptability of offering CARE via telehealth (TeleCARE). The secondary objective was to explore quantitative outcome trends and effect sizes postintervention outcomes of TeleCARE for both caregivers and care recipients. Rates of recruitment, attendance, and completion were used to assess the feasibility of TeleCARE. Data on technology use and telehealth-based adaptations were also collected. Acceptability was measured using participants' rated satisfaction with the intervention immediately postintervention. Questionnaires were administered at baseline and immediately and 3 months postintervention. Primary outcomes for exploratory analysis included NPS presence, severity, and caregiver NPS-related distress. Secondary outcomes included caregiver depression, anxiety, stress, self-efficacy, positive aspects of caregiving, and meaning and purpose in life. Of the 109 caregivers contacted for recruitment, 24 (22%) caregivers enrolled in TeleCARE, and 20 (83%) caregivers, predominantly female spouses, completed the study. Feedback from participants in the TeleCARE test group 1 (n=3) was used to modify the intervention to improve the telehealth experience, including adding procedures to improve safety, encourage rapport building, address etiquette, and ensure privacy. The final version of TeleCARE included 7 weekly synchronous video sessions. Ten out of 17 participants (59%) attended all 7 sessions, and all participants attended at least 5 sessions. Satisfaction ratings suggested adequate intervention acceptability. Most participants (11/17, 65%) required technological support, which was needed throughout the intervention. Quantitative trends were observed toward postintervention decreases in care-recipient NPS severity (Cohen d=0.16), caregiver depression (d=0.15), anxiety (d=0.23), and caregiver self-efficacy (d=0.21), as well as increases in positive aspects of caregiving (d=0.18) and meaning and purpose in life (d=0.09). Most improvements were not sustained at the 3-month follow-up. In this pilot feasibility study, dementia caregivers were successfully recruited and engaged in TeleCARE. Overall, TeleCARE was deemed feasible and acceptable. The current findings suggest that offering interventions via telehealth requires modifications and technological support for older caregiver engagement but is a feasible and acceptable means of offering services.

Despite the increasing interventions to support family caregivers of people with dementia, service planning and delivery is still not effective. Our study aimed to develop a digitally-supported needs assessment tool for family caregivers of people with dementia that is feasible, time-efficient, understood by users, and can be self-completed in the primary care setting. The development of the unmet needs assessment tool was part of a cluster-randomized controlled trial examining the effectiveness of a digitally supported care management programme to reduce unmet needs of family caregivers of people with dementia (GAIN [Gesund Angehörige Pflegen]) and was conducted in 3 phases. Using an iterative participatory approach with informal caregivers, health care professionals including general practitioners, neurologists, psychologists, psychiatrists, nurses, and Alzheimer Society representatives, we developed a digital self-completion unmet needs assessment tool focusing on informal caregivers' biopsychosocial health und quality of life in connection to their caregiver responsibilities. Data were collected through group discussions, written feedback, protocols, think-aloud protocols, and interviews, and analyzed thematically. Data from 27 caregivers, including caregivers of people with dementia (n=18), health care professionals (n=7), and Alzheimer Society representatives (n=2) were collected. Thematic analysis identified 2 main themes: content of the assessment tool and usability and handling of the digital tablet-based assessment tool. The feedback provided by the stakeholders led to new aspects and changes to make the tool comprehensive, easy to read, and easy to handle. The overall mean completion time was reduced from the initial 37 minutes to 18 minutes, which renders the assessment tool fit to be self-completed in waiting rooms of primary care practices or other settings. The input of the 3 stakeholder groups has supported the development of the assessment tool ensuring that all aspects considered important were covered and understood and the completion of the assessment procedure was time-efficient and practically feasible. Further validation of the assessment tool will be performed with the data generated as part of the GAIN trial.

Asynchronous online forums provide flexible, accessible peer support for many people living with dementia and carers. Moderators are central to the functioning of these communities, yet little is known about their experiences. This study explored the experiences of individuals moderating an online dementia forum, including their motivations, perceived benefits, challenges, and suggestions for improvements. Moderators from a UK-based online dementia support forum were recruited using purposive sampling via forum administrators. Between January and March 2025, 5 moderators, all with dementia care experience, participated in remote semistructured interviews. Interview topics included pathways into moderation, perceptions of the moderator role, experiences of supporting forum members, challenges encountered, perceived personal benefits, and views on the future development of online support communities. Interviews were transcribed verbatim and analyzed using reflexive thematic analysis. Four themes were produced: (1) \"from support seeker to support provider\": moderators primarily identified as community members rather than authority figures, following a trajectory from receiving support as a carer to actively facilitating community support; (2) \"understanding through shared experience\": lived experience of dementia was seen as essential for empathy, credibility, and sensitive responses, though sometimes prompted strong emotional reactions; (3) \"giving back and gaining in return\": moderation offered purpose, structure, and social connection, particularly postretirement and following transition out of caring; (4) \"balancing growth with community preservation\": forum expansion increased workload, spam management demands, and safeguarding responsibilities, and moderators were cautious about social media-style features and artificial intelligence-generated content undermining the effectiveness of support exchanges. Moderators play a crucial, value-driven role in sustaining dementia support forums, extending beyond administrative duties. The findings suggest that moderators occupy a distinctive position as both recipients and providers of peer support, drawing on experiential expertise to maintain trust and community cohesion. Forum growth and technological innovations present opportunities and challenges, highlighting the need to balance scalability with authenticity in online support communities.

Family carers of older adults often experience significant mental health challenges, including anxiety and depression. Although online coaching interventions have been found to reduce anxiety and depressive symptoms in carers, only a few studies have examined the broader impact of applying online self-help interventions for enhancing resilience and overall well-being in carers. This study evaluates the effectiveness of a self-directed e-coaching intervention for family carers of older adults aimed at reducing anxiety and depressive symptoms, while also assessing its impact on enhancing their resilience and overall well-being, particularly for those with mild levels of carer needs. This study aims to evaluate the effectiveness of a self-directed e-coaching intervention in reducing symptoms of anxiety and depression among carers of older adults using the 7-Item Generalized Anxiety Disorder Scale (GAD-7) and 9-Item Patient Health Questionnaire (PHQ-9), respectively, and also to examine secondary outcomes to determine its broader impact, including improvement in the level of carer needs, quality of life, caregiving burden, self-care efficacy, and resilience. This is a 3-arm randomized controlled trial that involves family carers of older adults living in Hong Kong, who will be randomly assigned to one of the e-coaching intervention groups or the control group through an online platform. The e-coaching intervention will consist of structured modules for self-directed learning on lifestyle intervention, family relationships, and emotion regulation. Participants in the intervention groups will either receive full content or partial content tailored to their caregiving needs. A total of 240 participants will complete the GAD-7 and PHQ-9 assessments at baseline, postintervention, and at a 3-month follow-up to evaluate changes in anxiety and depression scores. Secondary outcome measures will include standardized measurements assessing the level of carer needs, quality of life, caregiving burden, self-care efficacy, and resilience. It is hypothesized that participants in both e-coaching intervention groups will demonstrate a statistically significant reduction in anxiety and depressive symptoms at both postintervention and 3-month follow-ups compared to the control group, in terms of reductions in GAD-7 and PHQ-9 scores. This randomized trial was funded for an original project period from January 2023 to January 2028. The enrollment commenced in April 2025 and is ongoing, with the expectation of closing enrollment in May 2026. We anticipate that data analyses will be completed by September 2026. The anticipated findings from this study could provide valuable insights into the potential of e-coaching as an accessible self-help intervention for improving mental health outcomes among carers of older adults, particularly those classified with mild levels of carer needs. If successful, this self-directed approach may offer a scalable solution to alleviate psychological distress and enhance overall well-being and resilience in this vulnerable population. The results will inform future mental health strategies and interventions tailored for carers, ultimately fostering a healthier caregiving environment.