Preventing Aggression in Veterans with Dementia

预防患有痴呆症的退伍军人的攻击行为

• 批准号: 8305962
• 负责人: Mark E. Kunik
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-05-01 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8305962
• 关键词: Address; Advocate; Affect; Aggressive behavior; Agitation; Alzheimer' s Disease; Antipsychotic Agents; Area; Attention; Behavior Therapy; Behavioral; Books; Boxing; Caregiver Burden; Caregivers; Caring; Chronic; Clinic; Communication; Dementia; Development; Diagnosis; Discipline of Nursing; Distress; Educational Materials; Event; Family; Funding; Goals; Grant; Haloperidol; Health Services; Home environment; Incidence; Injury; Institutionalization; Intervention; Life; Medical; Memory; Mental Depression; Mental disorders; Methods; Modeling; Moods; Morbidity - disease rate; Multimedia; Outcome; Pain; Patients; Persons; Pharmaceutical Preparations; Play; Practice Guidelines; Prevalence; Preventive; Primary Health Care; Problem behavior; Provider; Randomized; Randomized Controlled Trials; Recruitment Activity; Research; Research Personnel; Risk; Risk Factors; Role; Sampling; Severities; Telephone; Testing; United States Food and Drug Administration; Veterans; aggression prevention; base; clinical practice; cohort; cost; depressive symptoms; evidence base; improved; injury burden; innovation; mortality; novel strategies; olanzapine; prevent; primary outcome; psychoeducational; psychoeducational intervention; psychologic; psychosocial; secondary outcome; skills

6. PROJECT SUMMARY/ABSTRACT Project Background/Rationale Dementia is one of the most costly chronic conditions in the VA.1 In 2008, 175,621 VA patients had a dementia diagnosis; and the prevalence will increase to 218,017 in 2017.1 Although dementia is primarily defined by memory disturbances, many financial and psychosocial costs are associated with its frequent concurrent medical disorders and psychological/behavioral disturbances. The 2008 Dementia Steering Committee recommended that the VHA fund more research on nonpharmacologic interventions to address behavioral disturbances that occur in 80% of persons with dementia. The investigators of this study have a sustained record of scientific findings that point to the urgent need for new approaches to address aggression, which occurs in 40% of Veterans with dementia and often is not addressed,2 leading to increased institutionalization, injuries, and use of antipsychotic medications.3 A recently completed HSR&D IIR grant4 (IIR 01-159-2), "Causes and Consequences of Aggression in Persons with Dementia," found that pain was among the strongest predictors of aggression.5 The prevalence of pain in persons with dementia is known to be about 50%.6 Project Objectives/Aims Innovative approaches are urgently needed to replace the model of treating aggression with tranquilizing medications. No medications are more than modestly efficacious for treating aggression in persons with dementia. However, antipsychotic medications are commonly prescribed, despite limited efficacy and "black- box" warnings of the increased mortality and morbidity associated with these medications in persons with dementia. We have developed an innovative, psychoeducational intervention that aims to prevent the development of aggression in dementia patients with pain and is guided by empirical evidence regarding mutable risk factors for aggression. As such, the objectives of this proposal are to assess whether this intervention, Preventing Aggression in Veterans with Dementia (PAVeD), 1) decreases incidence of aggression; 2) decreases pain and depression; 3) decreases caregiver burden and improves the caregiver- patient relationship; 4) increases pleasant events; and 5) decreases injuries, use of antipsychotic medication, and nursing-home use. Project Methods The proposed project is a randomized, controlled trial of PAVeD, a 6-8 session, home-based psychoeducational, caregiver/patient intervention. We will recruit 220 dyads (patients with mild-to-moderate dementia and pain who receive care in primary care clinics, and a primary caregiver). Dyads will be randomized to the PAVeD intervention or to an enhanced usual primary care condition (EU-PC). PAVeD uses didactics, role-playing, and multimedia (e.g., books and DVDs). The 6-8 modules will include 4 core modules that address recognizing and treating pain, increasing pleasant activities, and improving patient-caregiver communication. Two to 4 additional elective sessions, selected according to the needs of the dyad, further enhance skills related to these core topics. The EU-PC will include providing the patient and caregiver educational materials on dementia and pain, notifying the primary care provider of the patient's level of pain, and 8 weekly supportive telephone calls to caregivers. The PAVeD group will also receive all EU-PC components.

6. 项目概要/摘要 项目背景/理由 痴呆症是退伍军人事务部最昂贵的慢性疾病之一。1 2008 年，175,621 名退伍军人事务部患者患有痴呆症 诊断;到 2017 年，患病率将增至 218,017 例。1 尽管痴呆症的主要定义是 记忆障碍，许多经济和社会心理成本与其频繁并发有关 身体疾病和心理/行为障碍。 2008 年痴呆症指导委员会 建议 VHA 资助更多非药物干预研究，以解决行为问题 80% 的痴呆症患者都会出现这种症状。这项研究的研究者持续 科学发现的记录表明迫切需要新的方法来解决侵略问题， 40% 的退伍军人患有痴呆症，但往往得不到解决，2 导致收容机构增加， 损伤和抗精神病药物的使用。3 最近完成的 HSR&D IIR 拨款4 (IIR 01-159-2)， “痴呆症患者攻击行为的原因和后果”发现，疼痛是导致痴呆症的原因之一。 攻击行为的最强预测因子。5 据了解，痴呆症患者的疼痛患病率约为 50%.6 项目目标/目标 迫切需要创新方法来取代用镇静治疗攻击性的模式 药物。对于治疗患有此类疾病的人的攻击性行为，没有任何药物能起到一定的效果。 失智。然而，尽管疗效有限且“黑- 框”警告与这些药物相关的患者死亡率和发病率增加 失智。我们开发了一种创新的心理教育干预措施，旨在预防 患有疼痛的痴呆症患者攻击行为的发展，并以以下经验证据为指导 攻击行为的可变风险因素。因此，本提案的目的是评估这是否 干预措施，预防患有痴呆症的退伍军人的攻击行为 (PAVeD)，1) 降低以下行为的发生率： 侵略; 2）减轻疼痛和抑郁； 3）减轻护理人员的负担并提高护理人员的水平 患者关系； 4）增加愉快的事件； 5) 减少伤害、抗精神病药物的使用， 和疗养院使用。 项目方法 拟议项目是一项 PAVeD 随机对照试验，为期 6-8 次，以家庭为基础 心理教育、护理人员/患者干预。我们将招募 220 名双人组（轻至中度患者） 在初级保健诊所接受护理的痴呆症和疼痛患者以及初级护理人员）。双人将是 随机分配至 PAVeD 干预组或增强型常规初级保健条件组 (EU-PC)。 PAVeD 用途 教学法、角色扮演和多媒体（例如书籍和 DVD）。 6-8模块将包括4个核心模块 旨在识别和治疗疼痛、增加愉快的活动以及改善患者护理人员 沟通。根据两人的需要选择两到四门额外的选修课程，进一步 增强与这些核心主题相关的技能。 EU-PC 将包括向患者和护理人员提供 关于痴呆症和疼痛的教育材料，告知初级保健提供者患者的疼痛程度， 每周 8 次给护理人员的支持性电话。 PAVeD 集团还将收到所有 EU-PC 成分。