METRIcAL - Music & MEmory: a Pragmatic TRIal for Nursing Home Residents with ALzheimer's Disease

韵律 - 音乐

基本信息

批准号：
10219946
负责人：
Vincent Mor
金额：
$ 95.89万
依托单位：
BROWN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-15 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10219946
关键词：
Address Adherence Adoption Affect Aggressive behavior Agitation Alzheimer&apos s Disease Alzheimer&apos s disease related dementia Anti-Anxiety Agents Antipsychotic Agents Anxiety Area Award Behavior Behavioral Symptoms Brain Cardiovascular system Caring Cessation of life Confusion Consent Consult Data Data Linkages Data Set Databases Dementia Disease Electronic Health Record Enrollment Evaluation Event Evidence based intervention Exhibits Feeling Foundations Fright Funding Goals Guidelines Intervention Link Measurement Medicare Memory Mental Depression Metadata Modeling Monitor Moods Music Nursing Homes Observational Study Outcome Pathway interactions Pharmaceutical Preparations Phase Population Prevalence Procedures Process Protocols documentation Provider Public Health Randomized Controlled Trials Recording of previous events Research Research Personnel Retirement Risk Secure Sensory Deprivation Site Standardization Symptoms Technology Testing Trainers Training Training United States Centers for Medicare and Medicaid Services Universities Variant Vital Status Waiting Lists adverse outcome aging population associated symptom base care providers data exchange design effective intervention efficacy evaluation evidence base executive function exhaust experience genetic linkage analysis improved improved outcome innovation insight memory encoding multidisciplinary negative affect nursing home length of stay off-label use pragmatic trial preference prevent primary outcome programs psychological symptom reduce symptoms response secondary outcome symptom treatment

项目摘要

PROJECT SUMMARY Evidence-based, non-pharmacological interventions that address the behavioral and psychological symptoms of dementia (BPSD) are a particularly high priority for nursing homes (NHs), where over 50% of long-stay residents have Alzheimer's disease-related dementias (ADRD) and the off-label use of antipsychotic medications to address BPSD is contraindicated due to serious adverse consequences. Studies have demonstrated that individualized music can reduce anxiety, decrease negative affect or depression, and control physically-agitated behaviors in people with ADRD. Eliciting musical memories using familiar or preferred music may decrease feelings of isolation and anxiety, as musical memories are encoded in areas of the brain affected later in the ADRD process than areas of the brain involved in verbal memory and executive functioning. MUSIC & MEMORYSM (M&M) is a music program that involves using inexpensive iPod technology to deliver individualized music to people with ADRD. The intervention's potential is illustrated powerfully in the award-winning 2014 documentary, Alive Inside, which shows residents with severe dementia begin to move, sing, and interact with others when listening to their favorite music on iPods. Retrospective Brown University analyses found that residents' BPSD symptoms decreased faster among NHs participating in M&M vs. pair-matched controls. However, state demonstration programs and other projects demonstrate that implementation of M&M varies widely. As a first step to standardizing delivery of the program and evaluating efficacy, Brown and its partners developed an implementation guide, integrating experiences from statewide efforts with qualitative data about NH best practices. We propose to standardize the introduction and implementation of M&M during a one-year R21 pilot and then to test the impact of implementing M&M on NH residents' BPSD outcomes during a four-year R33 pragmatic trial. During the pilot, we will test a step-by-step protocol and validate data transfer and measurement procedures in four different NHs, one from each of four participating corporations; during the pragmatic trial, we will conduct a wedge-based, pragmatic cluster randomized controlled trial (RCT) and estimate the impact of M&M on residents' behaviors and medication use, as well as examine factors associated with variation in NHs' adherence to the program in 66 facilities. Using a waiting list control design will allow us to iteratively refine training and measurement, as needed, between waves of participating facilities. In both the pilot and the pragmatic trial, we will implement the program as a facility-level, protocol- driven, quality improvement project, targeting all eligible (moderate to severe ADRD) residents in participating facilities. We will conduct analyses using iPod metadata, electronic health record data, and Minimum Data Set resident assessments, all of which can be linked to Medicare enrollment and vital status data.

项目概要针对行为和心理症状的循证非药物干预措施痴呆症 (BPSD) 是疗养院 (NH) 的一个特别重要的优先事项，其中超过 50% 的长期入住者居民患有阿尔茨海默病相关痴呆症 (ADRD) 和超说明书使用抗精神病药物由于严重的不良后果，治疗 BPSD 的药物是禁忌的。研究表明，个性化音乐可以减少焦虑、减少负面情绪或抑郁症，并控制 ADRD 患者的身体激动行为。使用以下方法唤起音乐记忆熟悉或喜欢的音乐可能会减少孤独感和焦虑感，因为音乐记忆被编码在ADRD过程中受影响较晚的大脑区域比涉及语言记忆和语言记忆的大脑区域执行功能。 MUSIC & MEMORYSM (M&M) 是一个涉及使用廉价 iPod 的音乐程序为 ADRD 患者提供个性化音乐的技术。说明了干预措施的潜力 2014 年获奖纪录片《Alive Inside》中展现了这一点，该片展示了患有严重痴呆症的居民在 iPod 上聆听自己喜爱的音乐时，开始移动、唱歌并与他人互动。回顾性布朗大学分析发现，参与参与的 NH 居民的 BPSD 症状下降得更快 M&M 与配对对照。然而，国家示范计划和其他项目表明 M&M 的实施差异很大。作为标准化计划交付和评估的第一步为了提高效率，布朗及其合作伙伴整合了全州的经验，制定了实施指南关于 NH 最佳实践的定性数据的努力。我们建议在为期一年的 R21 试点期间标准化 M&M 的引入和实施，然后测试在四年 R33 期间实施 M&M 对新罕布什尔州居民 BPSD 结果的影响务实审判。在试点期间，我们将测试分步协议并验证数据传输和四个不同国家的测量程序，四家参与公司各一个；期间务实试验，我们将进行一项基于楔形的、务实的整群随机对照试验（RCT）估计 M&M 对居民行为和药物使用的影响，并检查因素与 66 个设施中 NH 遵守该计划的情况有关。使用等候名单控制设计将使我们能够根据需要在参与的浪潮之间迭代地完善培训和测量设施。在试点和务实试验中，我们将将该计划作为设施级、协议实施驱动的质量改进项目，针对所有符合条件（中度至重度 ADRD）的居民参与设施。我们将使用 iPod 元数据、电子健康记录数据和最小数据集进行分析居民评估，所有这些都可以与医疗保险登记和生命状态数据相关联。

项目成果

期刊论文数量（9）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Measuring Effects of Nondrug Interventions on Behaviors: Music & Memory Pilot Study.

衡量非药物干预对行为的影响：音乐

DOI：
发表时间：
2019-10
期刊：
影响因子：
6.3
作者：
McCreedy, Ellen M;Yang, Xiaofei;Baier, Rosa R;Rudolph, James L;Thomas, Kali S;Mor, Vincent
通讯作者：
Mor, Vincent

Measuring implementation fidelity in a cluster-randomized pragmatic trial: development and use of a quantitative multi-component approach.

衡量集群随机实用试验中的实施保真度：定量多成分方法的开发和使用。

DOI：
发表时间：
2022-01-15
期刊：
影响因子：
2.5
作者：
Olson, Miranda B;McCreedy, Ellen M;Baier, Rosa R;Shield, Renée R;Zediker, Esme E;Uth, Rebecca;Thomas, Kali S;Mor, Vincent;Gutman, Roee;Rudolph, James L
通讯作者：
Rudolph, James L

Personalization of Reminiscence Therapies in the Nursing Home Setting: Lessons from an Embedded Pragmatic Trial of a Music Intervention.

疗养院环境中回忆疗法的个性化：音乐干预嵌入式实用试验的经验教训。

DOI：
发表时间：
2023-09
期刊：
影响因子：
7.6
作者：
Davoodi, Natalie M;Dionne, Laura;Mor, Vincent;McCreedy, Ellen M
通讯作者：
McCreedy, Ellen M

Pragmatic Trial of Personalized Music for Agitation and Antipsychotic Use in Nursing Home Residents With Dementia.

针对痴呆症疗养院居民的躁动和抗精神病药物使用的个性化音乐的实用试验。

DOI：
发表时间：
2022-07
期刊：
影响因子：
7.6
作者：
McCreedy, Ellen M;Sisti, Anthony;Gutman, Roee;Dionne, Laura;Rudolph, James L;Baier, Rosa;Thomas, Kali S;Olson, Miranda B;Zediker, Esme E;Uth, Rebecca;Shield, Renée R;Mor, Vincent
通讯作者：
Mor, Vincent

Using Structured Observations to Evaluate the Effects of a Personalized Music Intervention on Agitated Behaviors and Mood in Nursing Home Residents With Dementia: Results From an Embedded, Pragmatic Randomized Controlled Trial.

使用结构化观察评估个性化音乐干预对患有痴呆症的疗养院居民的烦躁行为和情绪的影响：嵌入式、务实的随机对照试验的结果。

DOI：
发表时间：
2024-03
期刊：
影响因子：
0
作者：
Sisti, Anthony;Gutman, Roee;Mor, Vincent;Dionne, Laura;Rudolph, James L;Baier, Rosa R;McCreedy, Ellen M
通讯作者：
McCreedy, Ellen M