Promoting Reengagement in Daily Meaningful Activity Intervention for Adults with Mild Cognitive Impairment and Their Caregivers

促进轻度认知障碍成年人及其照顾者重新参与日常有意义的活动干预

• 批准号: 10378058
• 负责人: Yueh-Feng Yvonne Lu
• 金额: $ 52.53万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-05 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10378058
• 关键词: Active Listening; Activities of Daily Living; Address; Adult; Aging; Agreement; American; Anxiety; Assisted Living Facilities; Behavior Therapy; Caregiver Burden; Caregivers; Caring; Cognitive; Communication; Communities; Control Groups; Data; Dementia; Effectiveness of Interventions; Elderly; Exercise; Family; Family Caregiver; Fostering; Frustration; Future; Goals; Health; Health Promotion; Impairment; Intervention; Intervention Studies; Judgment; Knowledge; Learning; Life; Medication Management; Memory; Mental Depression; Modeling; Nurses; Outcome; Participant; Patient Care; Patient-Focused Outcomes; Patients; Perception; Performance; Persons; Pilot Projects; Problem Solving; Questionnaires; Randomized; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Reporting; Risk; Sampling; Self Efficacy; Self Management; Socialization; Support Groups; Symptoms; Testing; Time; Translations; Work; attentional control; base; cognitive training; depressive symptoms; design; efficacy evaluation; executive function; experience; improved; interest; mild cognitive impairment; multi-component intervention; nutrition; patient engagement; patient home care; prospective; satisfaction; skills; social; symptomatic improvement

PROJECT ABSTRACT This study examines efficacy of a theoretically-based, positive health focused, tailored, nurse-delivered, family- centered intervention: “Daily Engagement in Meaningful Activity” (DEMA). DEMA is designed for older persons with mild cognitive impairment (MCI) and family caregivers. Nearly 20% of Americans over 65 have MCI. Patients with MCI (patients) experience reduced life satisfaction due to patients’ increasing lack of confidence and diminished ability to perform meaningful and/or important activities, leading to diminished meaningful activity engagement, depressive symptoms, and anxiety. Caregivers lack confidence to manage their own and their patient’s daily challenges, leading to high caregiver burden, depressive symptoms, and anxiety. Patients and caregivers (dyads) report diminished satisfaction with their communication and relationship due to disagreements regarding the patient’s functional ability. Patient/caregiver behavioral interventions are more successful when they occur before progression to dementia. Previous cognitive intervention studies used limited, single domain foci (e.g., cognitive training, exercise, or nutrition) that may not be meaningful enough to sustain patient engagement long enough to improve life satisfaction. Emerging evidence, including our pilot studies, suggests regular engagement in self-identified meaningful activities can improve life satisfaction and depression and reduces risk of developing dementia. The purpose of this randomized controlled trial is to determine efficacy of DEMA compared to an information support (IS) attention control group. DEMA: 1) fosters active listening to increase dyad agreement in perceptions of patient functional ability; 2) helps dyads enhance engagement in and satisfaction with self-identified meaningful activities through problem solving to assess, prioritize, and achieve identified meaningful activity goals; 3) builds on patient’s existing interests and skills; and 4) provides information and didactic support to address priority concerns and dyad adjustment to functional changes and plan for the future. Specific aims are: 1) test DEMA’s efficacy for improve patient/ caregiver life satisfaction; 2) test DEMA’s efficacy to improve activity performance, depressive symptoms and anxiety in patients and burden, depressive symptoms, anxiety in caregivers; and, 3) explore a sub-sample of patients with higher depressive symptoms for improvement in health outcomes over time, compared to non- depressed patients. Eligible patient/caregiver dyads (n = 200) will be randomized to a 7-session DEMA or IS intervention, with data collected at baseline and 3 times over 9 months. Mixed model effects will be analyzed. If efficacious, DEMA will provide high impact on the care of patients and caregivers by maintaining their engagement in meaningful activities to improve patient and caregiver life satisfaction, depressive symptoms, anxiety, relationship satisfaction, activity performance, and caregiver burden. It will also provide information regarding the extent to which patients who have more depression may benefit and empirical evidence of the effectiveness of an intervention for translation into practice.

项目摘要 这项研究检查了基于理论，积极健康的，量身定制，保养的，家庭的效力 中心干预：“每天参与有意义的活动”（DEMA）。 Dema是为老年人设计的 有轻度的认知障碍（MCI）和家庭护理人员。近20％的美国人超过65岁。 MCI（患者）患者由于患者缺乏信心而导致的生活满意度降低 并降低执行有意义和/或重要活动的能力，从而导致有意义的人 活动参与，抑郁症状和动画。照顾者缺乏管理自己的信心， 他们的患者的日常挑战，导致伯恩（Burnen）的高照顾者，抑郁症状和焦虑。 和看护人（二元组）报告减少了对他们的沟通和关系的满意度 关于患者功能能力的分歧。患者/照顾者的行为干预措施更多 当它们发生在痴呆症之前时，成功。以前使用的认知干预研究 有限的单个领域焦点（例如认知训练，锻炼或营养）可能不够有意义 维持足够长时间的患者参与度以提高生活满意度。新兴证据，包括我们的飞行员 研究表明，定期参与自我确定的有意义的活动可以提高生活满意度和 抑郁症并降低痴呆症的风险。这项随机对照试验的目的是 与信息支持（IS）注意控制组相比，确定DEMA的有效性。 Dema：1）福斯特 积极倾听会增加对患者功能能力的感知的二元共同的一致性； 2）帮助二元组增强 通过解决问题来评估，参与自我认同的有意义的活动并满意 优先考虑并实现确定的有意义的活动目标； 3）基于患者的现有兴趣和技能； 4）提供信息和教学支持，以解决优先问题和二元调整 功能变化和未来计划。具体目的是：1）测试DEMA改善患者的效率/ 照顾者的生活满意度； 2）测试Dema提高活动表现，抑郁症状和 患者和伯恩的焦虑，抑郁症状，看护人的动画； 3）探索一个子样本 与非 - 沮丧的患者。符合条件的患者/护理人员二元组（n = 200）将随机分为7条dema或IS 干预，基线收集的数据，在9个月内收集3次。混合模型效应将进行分析。 如果高效，DeMA将通过维护他们 参与有意义的活动，以提高患者和护理人员的生活满意度，抑郁症状， 焦虑，关系满意度，活动表现和照顾者伯恩（Burnen）。它还将提供信息 关于抑郁症更多的患者可能受益的程度 干预措施将翻译成实践的有效性。