Testing Dementia Caregiver TeleCoaching to Reduce Episodes of Abuse and Neglect by Recognizing and Managing Care-Resistant Behaviors

测试痴呆症护理人员远程辅导，通过识别和管理抗护理行为来减少虐待和忽视的发生

• 批准号: 10478199
• 负责人: RITA A JABLONSKI
• 金额: $ 69.59万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10478199
• 关键词: Address; Adult; Advisory Committees; Alzheimer' s Disease; Alzheimer' s disease related dementia; Area; Behavior; Behavioral Symptoms; Caregivers; Caring; Cessation of life; Consultations; Coping Skills; Coupled; Dementia; Dementia caregivers; Distress; Educational Intervention; Educational process of instructing; Elder Abuse; Elderly; Equation; Ethics; Family; Family Caregiver; Frequencies; Funding; Guilt; Health; Health system; Injury; Internet; Intervention; Intervention Studies; Knowledge; Lead; Learning; Mandatory Reporting; Mental Depression; Methods; Modeling; Oral cavity; Outcome; Participant; Patient Self-Report; Performance; Personal Satisfaction; Persons; Physical aggression; Problem Solving; Protocols documentation; Quality of Care; Randomized Clinical Trials; Reporting; Research; Research Priority; Resistance; Risk; Risk Factors; Schedule; Scientist; Series; Services; Stress; Surveys; Testing; Time; Training; Translations; Trust; United States National Institutes of Health; Waiting Lists; Work; abuse neglect; care recipients; caregiver bereavement; caregiver interventions; caregiving; design; diaries; disorder prevention; effectiveness testing; efficacy evaluation; efficacy testing; elder neglect; emotional abuse; evidence base; experience; family caregiving; follow-up; group intervention; instrument; intervention effect; online care; oral care; physical abuse; post intervention; practice setting; prevent; programs; recruit; telecoaching

PROJECT ABSTRACT In family caregiving situations, those with Alzheimer’s disease and related dementia (ADRD) are more likely to experience elder abuse and neglect (EAN) than older adults living alone or not requiring assistance with care. Elder abuse and neglect (EAN) is defined as acts committed by a person in a trusted relationship that cause actual or increased risk of harm to an older adults’ health and wellbeing. EAN consists of different subtypes such as physical and psychological abuse and neglect. About half of family caregivers for persons with dementia self- report doing at least one of these three EAN subtypes. This proposal evaluates an evidence-based tele-coaching intervention, Care-Resistant Behavior Internet Training (CuRB-IT) to enhance coping skills of family caregivers and reduce elder abuse and neglect (EAN). CRB includes actions taken by a person with ADRD to resist or refuse assistance with care, such as refusing to open their mouth for oral care or using physical aggression. Our tele-coaching intervention (CuRB-IT), which increases problem-solving coping skills by teaching practical strategies to manage CRBs, effectively reduces CRB-related caregiver distress. We will test the effectiveness of CuRB-IT in a delayed-intervention randomized clinical trial, within a multi-time series approach. Caregivers in immediate- and delayed-intervention groups (N=266) will complete 4 waves of instrument completion and daily diary surveys describing the frequency of CRB and EAN over a 21-day period at baseline, 3 months, 6 months, and 9 months. Delayed-intervention caregivers will receive weekly texts to reduce inflated intervention effects inherent in many wait-list control designs.22 After the 3-month follow-up, the delayed-intervention group will then receive the CuRB-IT intervention. This design allows us to maximize power to examine efficacy (between-group), mechanism-of-action, and intervention delay (within-group). Thus, we propose the following Specific Aims: 1) Test the efficacy of an online care-resistant behavior coaching intervention in reducing frequency of EAN (a) among the experimental (immediate-intervention group) as compared to the control (delayed-intervention group) (between groups) and (b) within-person from pre- to post- intervention.; 2) Test hypothesized mechanism of action through multi-level structural equation modeling to assess the relationships between CRB-stress appraisal, use of CuRB-IT problem-focused coping strategies and EAN; and 3) Examine intervention decay at 3- and 6-months post intervention to determine performance of intervention and inform scheduling of booster sessions. We will also assess the efficacy of the CuRB-IT intervention in preventing onset of EAN use by family caregivers as an exploratory aim. This proposal directly addresses high-priority research gaps identified by the NIH Office of Disease Prevention and US Preventative Task Force. Next steps in this research program will focus on translation to practice settings such as the UAB Health system’s Caregiver Bereavement Service Line and Adult Protective Services.

项目摘要 在家庭护理情况下，患有阿尔茨海默氏病和相关痴呆症（ADRD）的人更有可能 比单独生活或不需要护理帮助的老年人经历虐待和忽视（EAN）（EAN）。 虐待和忽视（EAN）的老年人被定义为一个受信任关系中的人所犯下的行为 实际或增加对老年人健康和福祉的伤害风险。 EAN由不同的亚型组成 作为身体和心理虐待和忽视。痴呆症患者的家庭护理人员中约有一半 报告至少这三个EAN亚型中的一种。该提案评估了基于证据的电信指导 干预，耐心行为互联网培训（CURB-IT），以提高家庭护理人员的应对能力 并减少旧的虐待和忽视（EAN）。 CRB包括ADRD患者以抵抗或 拒绝护理协助，例如拒绝张开口腔护理或使用身体侵略。我们的 电视教练干预（Curb-IT），通过教学实践来提高解决问题的应对技巧 管理CRB的策略有效地减少了与CRB相关的护理人员的困扰。我们将测试 在延迟干预的随机临床试验中，在多时间系列方法中遏制了IT。护理人员进入 立即和延迟干预组（n = 266）将完成4次仪器完成和每日 日记调查描述了CRB和EAN的频率在基线的21天，3个月零6个月， 和9个月。延迟干预护理人员将收到每周的文本，以减少膨胀的干预效果 在许多等待名单控制设计中固有的。22在3个月的随访之后，延迟干预组将 接受路缘干预。这种设计使我们能够最大程度地提高功率检查效率（组间）， 行动机理和干预延迟（组内）。这是我们提出以下特定目标：1） 测试在线抵抗护理行为教练干预措施的效率，以降低EAN的频率（a） 与对照（延迟干预组）相比，在实验性（直接干预组）中 （在组之间）和（b）从干预前到干预后的个人内部。 2）测试假设的机制 通过多级结构方程建模来评估CRB压力之间的关系 评估，使用路边以问题为中心的应对策略和EAN； 3）检查干预衰减 干预后3个月和6个月，以确定干预的绩效并告知助推器的日程安排 会议。我们还将评估Curb-IT干预措施在防止家族使用EAN使用方面的效率 护理人员作为探索目标。该建议直接解决了由 NIH疾病预防办公室和美国预防工作组。该研究计划的下一步将 专注于翻译为练习设置，例如UAB卫生系统的护理人员丧亲服务线 和成人保护服务。