Virtual Outreach and Individualized Coaching Extension

This study tests whether a nurse-led program that uses a voice-controlled smart speaker in the home helps older adults better manage their chronic health conditions. It also examines which nursing staff and clinic resources would be needed to offer such a program in regular outpatient care.

Inclusion Criteria: * Age 65 years or older * Two or more chronic conditions * Mild cognitive impairment, defined as a Montreal Cognitive Assessment Blind (MoCA-Blind) score of 13 to 17, with no diagnosis of Alzheimer's disease or a related dementia * Living independently in a community-based setting (not residing in a nursing home or in assisted living with skilled nursing support) * Able to speak, read, and understand English * Able to provide informed consent for themselves, as confirmed at the time of consent * Home environment able to accommodate the study devices, including electrical power and a suitable location for an Echo Show * Willing and able to engage in a technology-based intervention, as indicated by a Yes response to an engagement-readiness item administered during screening Exclusion Criteria: * Diagnosis of Alzheimer's disease or a related dementia * Adults unable to consent for themselves * Individuals who are not able to clearly understand English * Severe uncorrected hearing or vision impairment that would prevent interaction with a voice-activated device with a screen * Planned relocation or absence from the home for an extended period during the 12-week study period * Concurrent enrollment in another intervention study addressing chronic disease self-management * Any medical, psychiatric, or social circumstance that, in the judgment of the study team, would prevent safe participation or completion of study procedures