Project: Farm Safety for Rural Families Coping with Dementia

Project Dates: 2023-2027

Research type: Basic/etiologic

Investigators and Students:

Principal Investigators:

Kanika Arora, PhD, Associate Professor of Health Management and Policy, University of Iowa

Julie Bobitt, PhD, Assistant Professor in Department of Medicine, Center for Dissemination and Implementation Sciences (CDIS), University of Illinois at Chicago

Community Partners:  

Jeong Eun Lee, PhD, Assistant Professor of Human Development and Family Studies, Iowa State University

Chelsey Byers, M.A., Family Life Educator, University of Illinois Extension

Tina Thomas, M.S., Associate Director of Community Engagement, The Alzheimer’s Association

Technical Experts:

Josie Rudolphi, PhD, Assistant Professor, Agricultural and Biological Engineering, University of Illinois

Natalie Denburg, PhD, Associate Professor of Neurology, University of Iowa

Study Background

Older agricultural workers experience greater odds of developing dementia. Dementia is a neurocognitive disorder that heightens injury risk among cognitively impaired older agricultural workers. Persons living with dementia (PLwD) rely on family members to protect them from serious harm. But studies show that caregivers lack knowledge on dementia progression and require specific direction on navigating safety concerns and communicating effectively with PLwD. Existing educational interventions focused on increasing caregiver competence for addressing dementia-related home safety risks have been shown to increase caregiver knowledge, lower caregiver strain and reduce the probability of risky behaviors and accidents among PLwD. However, these do not address multifaceted safety and cultural concerns unique to coping with dementia in agricultural settings.

Guided by the socio-ecological framework, this intervention will train Cooperative Extension Specialists to provide structured education to family caregivers of persons with suspected or diagnosed dementia who live/work on a farm. The intervention will be finalized in collaboration with a research-community advisory team. The advisory team will represent farm families, clinicians, implementation scientists, aging researchers, and experts from Cooperative Extension and the Alzheimer’s Association. Based on preliminary work, the intervention is anticipated to comprise of four modules: 1) dementia disease education; 2) dementia progression and farm safety; 3) communicating with dementia patients in agricultural settings; and 4) resources for rural dementia patients and caregivers. Using a staggered approach, the program will be delivered virtually by four Extension Specialists from Iowa State University and University of Illinois to 100 farm families in Iowa (N=50) and Illinois (N=50). We will conduct a two-arm randomized controlled trial with an intervention group and a wait- list control group. We will assess efficacy (family caregiver’s dementia knowledge, burden, and self-efficacy, and PLwD’s farm safety risk) and implementation processes (feasibility, acceptability, and fidelity). Given the national potential to be replicated in other states. The results from this study will provide a foundation for a larger-scale hybrid effectiveness-implementation trial.

Specific Aims

Specific Aim 1: Finalize Farm Families Coping with Dementia (toolkit and implementation protocol) and train cooperative extension specialists in Iowa and Illinois to deliver the program.

We will conduct formative research and finalize FFCD toolkit (consisting of educational modules identified to support farm families coping with dementia) and implementation protocol in collaboration with advisory team. Train ES on FFCD delivery.

Specific Aim 2: Evaluate Farm Families Coping with Dementia efficacy in improving family caregiver’s dementia knowledge, burden, and self- efficacy, and PLwD’s farm safety risk.

We will conduct a two-arm randomized control trial involving an intervention- and a waitlist control group. Compare participant data from baseline and 3-month follow-up surveys. Interview a sample of family caregivers to explore participant experience in Farm Families Coping with Dementia.

Specific Aim 3: Evaluate implementation outcomes (feasibility, acceptability, and fidelity).

We will assess feasibility and acceptability from the perspectives of participants and ES through course evaluations and interviews. Assess fidelity by observing program delivery and completing and analyzing a fidelity checklist.


The long-term significance of this study is that it will provide Extension educators and farm families concrete skills in navigating actions and discussions surrounding safety of agricultural PLwD.

At study completion, an educational intervention for farm families coping with dementia will be generated. Evaluation results will be shared at professional conferences and published in peer-reviewed journals. For translation, these outputs will be shared with the Alzheimer’s Association and North Central Region Aging Network, a collaborative of Extension professionals dedicated to improving health of rural older adults.

This study responds to NIOSH strategic priority 7.17.1 (reduce farm injuries related to mental health), extramural research priority 6.1D/G (reduce traumatic injuries) as well as the regional need of protecting vulnerable aging farmers.  Given the national scope of Extension, this program has strong potential to be replicated in other states.  The results from this study will provide a foundation for a larger-scale hybrid effectiveness-implementation trial.

Publications from this 2023-2027 Study

When the project is further along and we have results to share, we’ll post information here about publications and presentations.