Onward Door-Through-Door Companion Rideshare Technology to Improve Care for Older Adults and Individuals with Alzheimer's Disease and Related Dementias (AD/ADRD)

Abstract Social determinants of Health (SDoH) drive 80% of health outcomes and transportation is the third most prominent SDoH in the United States, impacting nearly all other social determinants. A lack of access to easy, reliable transportation causes over 5.8 million Americans to miss their healthcare appointments each year (Wolfe et al, 2020). Traditional transportation solutions like curb-to-curb rideshare, taxis, and buses are often unreliable or unsafe for vulnerable populations including older adults with mobility impairments and those suffering from Alzheimer’ disease or Alzheimer’ disease related dementias (AD/ADRD) (Fraade-Blanar et al, 2021). In the United States, 5.7 million people suffer from AD/ADRD, which are projected to grow to 13.8 million (Alzheimer’s Association, 2018). Additionally, 26% of individuals with AD/ADRD live alone in the community (Alzheimer’s Association, 2018). Onward, a California based small business, has developed a technology enabled door-through-door rideshare service with a companion driver trained to support older adults and individuals with mild to moderate AD/ADRD. Drivers are certified in CPR and first aid, and have received training in supporting patients with AD/ADRD or post-sedation care, elder abuse and neglect prevention, communicating with special needs patients, infection control, fall avoidance, cultural humility, HIPAA, and other subjects that enable them to safely and effectively transport riders, particularly older adults with AD/ADRD. Further, transportation is the number one type of caregiving support provided in the United States. Eight out of 10 caregivers consider transportation a primary responsibility and 40% of them spend five or more hours per week providing and coordinating transportation (AARP; NADTC 2018). This demonstrates the demand for transportation solutions and the opportunity to reduce caregiver stress with transportation interventions. In this Phase II project, we aim to (1) conduct a RCT to evaluate the impact of door-through-door rideshare services with a trained companion driver on missed appointments for older adults and patients with AD/ADRD, (2) enhance the rider-driver matching capabilities of our technology platform, and (3) to demonstrate the ability to replicate the solution in other geographies that have different ride density and rider demographics.