Caregiver's Role in Hospitalizing Nursing Home Residents with Advanced Dementia

护理人员在患有晚期痴呆症的疗养院居民住院中的作用

基本信息

批准号：
8701459
负责人：
JANE L GIVENS
金额：
$ 24.56万
依托单位：
HEBREW REHABILITATION CENTER FOR AGED
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-05-15 至 2016-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8701459
关键词：
Accounting Acute Advance Care Planning Advance Directives Adverse event Aging American Benefits and Risks Care given by nurses Caregivers Caring Clinical Clinical Research Communication Continuity of Patient Care Databases Decision Making Dementia Distress Expenditure Family Family member Frequencies Future Geriatric Nursing Geriatrics Goals Healthcare Home Nursing Care Hospitalization Hospitals Interdisciplinary Study Intervention Interview Length of Stay Long-Term Care Nursing Medical Medicare Mission Nurses Nursing Homes Pain Patients Perception Personal Satisfaction Physicians Population Procedures Process Provider Proxy Qualitative Methods Qualitative Research Quality of life Recruitment Activity Research Research Methodology Risk Role Sampling Science Skilled Nursing Facilities Structure Telephone Interviews United States National Institutes of Health advanced dementia adverse outcome cohort effective therapy end of life experience improved novel preference prospective psychological distress public health relevance risk perception satisfaction shared decision making therapy design

项目摘要

DESCRIPTION (provided by applicant): The majority of the estimated 5 million Americans with dementia will be cared for in nursing homes (NH), where they will be at risk of hospitalization for the management of acute illnesses. Hospitalizations in this population are costly, may have limited clinical benefit, increase the likelihood of aggressive interventions, and may result in impaired family member well-being. Although health care proxy (HCP) preferences are a major factor in decisions to transfer NH residents to the hospital, there is a fundamental gap in our understanding of their role in decision-making regarding hospitalizations, their perceptions of the risks and benefits of hospitalization, and how the experience of hospitalization influences advance care planning in the post-hospital period. This study will employ an interdisciplinary research team with expertise in geriatric medicine, geriatric nursing science, qualitative research methods and dementia to explore the experience of HCPs in relation to hospitalization of NH residents with advanced dementia. To achieve this objective, we will recruit a prospective cohort of 50 NH residents with advanced dementia who are either transferred to the hospital, or in whom a decision was made not to hospitalize, and use qualitative methods to examine the following: 1. HCP's participation in the decision whether to hospitalize; 2. HCP's perceptions of their own experience and that of the resident during the hospitalization; 3. effect of the hospitalization on advance care planning regarding future hospitalizations; and 4. NH providers (nurses and physicians) perception of HCP's role in decisions concerning hospitalization and advance directives. The project will increase our understanding of how to support and engage HCPs to make well-informed decisions regarding hospitalizations of NH residents with advanced dementia.

描述（由申请人提供）：估计有 500 万患有痴呆症的美国人中的大多数将在疗养院 (NH) 接受护理，在那里他们将面临因治疗急性疾病而住院的风险。该人群的住院费用昂贵，临床获益可能有限，增加了积极干预的可能性，并且可能会导致家庭成员的福祉受损。尽管医疗保健代理 (HCP) 偏好是决定将新罕布什尔州居民转移到医院的一个主要因素，但我们对他们在住院决策中的作用、他们对住院风险和收益的看法的理解存在根本差距，以及住院经历如何影响出院后的预先护理计划。本研究将聘请一支在老年医学、老年护理科学、定性研究方法和痴呆症方面具有专业知识的跨学科研究团队，探讨 HCP 与患有晚期痴呆症的新罕布什尔州居民住院相关的经验。为了实现这一目标，我们将招募 50 名患有晚期痴呆的 NH 居民作为前瞻性队列，他们要么被转移到医院，要么决定不住院，并使用定性方法检查以下内容： 1. HCP 的参与决定是否住院； 2. 医护人员对自己和住院医师住院期间经历的看法； 3. 住院对未来住院预先护理计划的影响； 4. NH 提供者（护士和医生）对 HCP 在住院和预先指示决策中的作用的看法。该项目将加深我们对如何支持和参与 HCP 的了解，以便就患有晚期痴呆症的 NH 居民的住院做出明智的决定。