Comment on: Effectiveness of a Telephonic Aging Brain Care Model for Medicaid Home and Community Services for Dementia Patients and Their Caregivers

I read with great interest the article by Boustani et al. on the Effectiveness of Telephonic Aging Brain Care Model for Medicaid Home and Community Services for Dementia Patients and Their Caregivers 1. The authors should be commended for testing a scalable collaborative care approach in a socially vulnerable population 1. I would like to offer considerations regarding the interpretation of “social vulnerability” and the selection of study outcomes. The ABC Community program aims to improve access to dementia expertise and care coordination through protocol-driven telephone contacts, consistent with the American Geriatrics Society (AGS) position that telehealth can enhance access and continuity for older adults when implemented thoughtfully. The study's primary outcomes focus on individual symptoms and healthcare utilization. Although reductions in caregiver stress and improvements in well-being were observed, more granular measures of caregiver burden and household resilience are needed to clarify which components drive these benefits and whether they are equitably distributed across structurally disadvantaged dyads 1. Such metrics could include caregiver strain, preparedness, perceived support, stability of home care arrangements, or confidence in navigating complex services. Incorporating these measures may reveal whether reductions in acute care use occur alongside strengthened caregiver capacity rather than shifting burden onto already strained informal networks 2, 3. While the authors describe the population as “socially vulnerable,” vulnerability extends beyond dementia or comorbidity to include transportation, housing, language, and literacy barriers. Telephonic care addresses only part of these challenges. Future evaluations could explore how ABC interacts with structural constraints, including linkage to community-based resources, reductions in unmet social needs, or differential effects across neighborhoods with varying resource profiles. Finally, the AGS telehealth position statement emphasizes equity, accommodation of sensory and cognitive limitations, and support for caregivers 4. For individuals with advanced dementia, sensory impairments, or limited English proficiency, and for highly strained caregivers, telephone-only contacts may be insufficient for risk detection or complex decision-making. Identifying subgroups that may benefit from hybrid approaches combining telephone with in-person or video visits could guide policymakers considering broader implementation. In summary, the ABC model is promising, and incorporating caregiver and community-level outcomes, alongside analyses of heterogeneity across structural contexts, could enhance understanding of how telephonic collaborative dementia care supports socially vulnerable dyads to live well with dementia. S.I.N.d.R.C.F. conceived the letter, synthesized the literature, and drafted and revised the manuscript. The author has nothing to report. The sponsor had no role in this study. The author has nothing to report. The author declares no conflicts of interest.