IMPROVING HEALTH OUTCOMES IN UNPARTNERED CARDIAC ELDERS

改善没有伴侣的心脏病老人的健康状况

• 批准号: 6639289
• 负责人: SALLY Heller RANKIN
• 金额: $ 27.46万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-08-01 至 2006-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6639289
• 关键词: clinical research; clinical trials; coronary bypass; coronary disorder; human old age (65+); human subject; human therapy evaluation; myocardial infarction; nursing intervention; outcomes research; peer group; single person; social support network; statistics /biometry

As the greatest killer of all American men and women, heart disease causes disproportionately heavy burdens on unpartnered elders who have limited financial and social resources to contend with recovery demands and complications resulting either from myocardial infarction (MI) or coronary artery bypass graft surgery (CABG). Mobilization of community-based, elder peer advisors to provide low cost, low technology interventions is a novel approach to improving health outcomes for elders and was recently tested in NINR R15 NR4255. Building upon these findings the proposed trial tests a collaborative Advanced Practice Nurse (APN)/Peer Advisor to improve health outcomes for unpartnered elders recovering from MI or CABG. The aims are to 1) Test a collaborative APN/Peer Advisor intervention utilizing self-efficacy and social support that will improve general health status, lessen symptom incidence and severity, increase wellness behaviors, improve quality of life, reduce psychological distress, and improve adherence in cardiac elders; 2) Determine if a collaborative, community- based intervention for cardiac elders will encourage participation in phase II and III cardiac rehabilitation programs, and result in fewer cardiac related readmissions to the hospital; 3) Evaluate the collaborative APN/Peer Advisor intervention to determine if it differentially influences health outcomes in medically vs. surgically managed elders with CAD; 4) Determine if health outcomes and perceived social support for elder Peer Advisors improve following participation in an APN/Peer Advisor randomized trial. The study is randomized trial consisting of four groups (CABG with intervention vs. CABG control, and MI with intervention vs. MI control) who will be compared in a repeated measures design (n=232) at five data collection points from hospital discharge to one year post cardiac event. Sample criteria include unpartnered, over 65 years of age, medically stable male or female participants of any ethnic group able to speak and read English. The collaborative APN/Peer Advisor 12 week intervention utilizes self-efficacy and social support theory to enhance recovery outcomes following MI or CABG. Peer Advisors are those elders who have had either MI or CABG, have completed phase III cardiac rehabilitation programs and are trained to share their experiences of recovery, to assist in monitoring progress, and to provide social support; the APN is a cardiovascular nurse. The control group will receive care normally given to patients in the participating hospitals during outpatient treatment in the community. Data will be analyzed using repeated measures ANOVA/MANOVA. The outcome measures are: general health status (MOS SF-36), symptom incidence and severity (pain, shortness of breath, fatigue, GI symptoms), wellness behaviors (activities of daily living and exercise [Jenkins Activity Checklists]), quality of life (Quality of Life-Domains), psychological distress [POMS-Short Form), adherence to the medical regimen (MOS Adherence), participation in cardiac rehabilitation, and readmission to the hospital. Social support and self-efficacy are mediating variable sand will be measured by the MOS Social Support Scale and the Jenkins Self-Efficacy Expectation scales for Walking and General Activity.

作为所有美国男性和女性中最大的杀手，心脏病会造成不成比例的沉重负担，这些长者的财务和社会资源有限，以应对恢复需求和并发症，从而与心肌梗死（MI）或冠状动脉旁路旁路旁嫁接手术（CABG）产生的恢复需求和并发症。动员基于社区的同伴顾问提供低成本，低技术干预措施是改善长者健康成果的一种新型方法，最近在NINR R15 NR4255中进行了测试。在这些发现的基础上，拟议的试验测试是协作高级实践护士（APN）/同伴顾问，以改善从MI或CABG中恢复过的无与伦比的长者的健康成果。目的是1）测试利用自我效能和社会支持的协作APN/同伴顾问干预措施，这将改善一般健康状况，降低症状的发病率和严重性，提高健康行为，改善生活质量，减少心理困扰，并改善心脏长老的依从性； 2）确定对心脏长者的协作，基于社区的干预是否会鼓励参与II阶段和III阶段的心脏康复计划，并导致对医院的心脏相关读数较少； 3）评估协作APN/PEER顾问干预措施，以确定它是否会差异地影响使用CAD的医学和手术管理长老中的健康成果； 4）确定参加APN/同伴顾问随机试验后的健康结果和对同伴顾问的社会支持是否有所改善。该研究是由四组（包括干预与CABG控制的CABG组成的）随机试验，以及带有干预与MI控制的MI），将在重复措施设计（n = 232）中进行比较，从医院出院到心脏后一年的五个数据收集点。样本标准包括无与伦比的，超过65岁的任何能够说和阅读英语的种族的医学稳定的男性或女性参与者。协作APN/同伴顾问12周干预利用自我效能和社会支持理论来增强MI或CABG之后的恢复结果。同伴顾问是那些拥有MI或CABG的长辈，已经完成了III期心脏康复计划，并接受了培训，可以分享他们的康复经验，以帮助监视进度并提供社会支持； APN是心血管护士。对照组将在社区门诊治疗期间正常接受参与医院的患者的护理。将使用重复测量方差分析/MANOVA分析数据。 The outcome measures are: general health status (MOS SF-36), symptom incidence and severity (pain, shortness of breath, fatigue, GI symptoms), wellness behaviors (activities of daily living and exercise [Jenkins Activity Checklists]), quality of life (Quality of Life-Domains), psychological distress [POMS-Short Form), adherence to the medical regimen (MOS Adherence), participation in cardiac rehabilitation, and再入院。社会支持和自我效能感是介导的变量沙子，将通过MOS社会支持量表和詹金斯的自我效能感预期量表来衡量，以进行步行和一般活动。

项目成果

Partnerships in mending hearts: nurse and peer intervention for recovering cardiac elders.

修复心脏方面的伙伴关系：护士和同伴对心脏病老人的康复干预。

• DOI: 10.1097/00005082-200405000-00007
• 发表时间: 2004
• 期刊: The Journal of cardiovascular nursing
• 作者: Winder,PatriciaA;Hiltunen,ElizabethF;Sethares,KristenA;Butzlaff,Alice
• 通讯作者: Butzlaff,Alice

Implementation of efficacy enhancement nursing interventions with cardiac elders.

对心脏病老人实施效能强化护理干预措施。

• DOI: 10.1002/j.2048-7940.2005.tb00116.x
• 发表时间: 2005
• 期刊: Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses
• 作者: Hiltunen,ElizabethF;Winder,PatriciaA;Rait,MichelleA;Buselli,ElizabethF;Carroll,DianeL;Rankin,SallyH
• 通讯作者: Rankin,SallyH