Intervention for Disabling Anxiety in Older Adults Injured By Falls

针对跌倒受伤老年人的失能性焦虑的干预措施

• 批准号: 8701043
• 负责人: NIMALI JAYASINGHE
• 金额: $ 15.84万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-13 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8701043
• 关键词: Accidents; Address; Adult; Affect; American; Anxiety; Anxiety Disorders; Area; Arousal; Award; Behavioral; Belief; Caring; Clinical; Cognitive; Communities; Complement; Consultations; Critical Care; Data; Diagnosis; Discipline; Doctor of Philosophy; Elderly; Elements; Enrollment; Event; Evidence based treatment; Exposure to; Faculty; Fall prevention; Familiarity; Feasibility Studies; Fellowship; Foundations; Funding; Geriatric Psychiatry; Goals; Health; Health Professional; Health Services Research; Healthcare; Home environment; Hospitals; Informed Consent; Injury; Intervention; K-Series Research Career Programs; Knowledge; Life; Literature; Master of Public Health; Medicare; Mental Depression; Mental Health Services; Mental disorders; Mentors; Mentorship; Modification; New York City; Participant; Patients; Phobic anxiety disorder; Physical Rehabilitation; Physiological; Population; Post-Traumatic Stress Disorders; Procedures; Process; Psychopharmacology; Psychotherapy; Quality of life; Randomized; Randomized Controlled Trials; Readiness; Recruitment Activity; Relaxation Therapy; Research; Research Design; Research Personnel; Research Training; Resources; Sampling; Severities; Social support; Solid; Specialist; Specific Phobia; Stress; Structure; Symptoms; Testing; Training; Trauma; Treatment Efficacy; Underserved Population; United States National Institutes of Health; Work; base; career; clinical efficacy; clinically significant; communication behavior; coping; design; effective therapy; eligible participant; evidence base; experience; falls; fear of falling; follow-up; geriatric mental health; improved; injured; innovation; medical schools; meetings; member; older patient; post-traumatic stress; programs; psychoeducation; psychologic; public health relevance; skills; social; therapy development

DESCRIPTION (provided by applicant): "Intervention for disabling anxiety in older adults injured by falls" The goal of this application is to establish myself as an independent investigator who develops interventions for disabling anxiety in older adults injured by falls. Each year, millions of older Americans experience a threat to life or serious injury because of a fall. Despite increasing recognition of the psychological consequences of falling, advances in knowledge of trauma have yet to be applied to this population. My four training goals will be: (1) To deepen my understanding of pre-existing factors that may complicate treatment of older patients; (2) To broaden my familiarity with the process of physical rehabilitation for older patients; (3) To strengthen my ability to integrate knowledge of psychopharmacology in the development of interventions for older patients; and (4) To acquire the skills and data needed to design studies of the efficacy of clinical interventions. The proposed program of coursework, meetings with internal and external consultants, and research will be completed under the mentorship of JoAnn Difede, Ph.D., and Martha Bruce, Ph.D., M.P.H. I will use institutional resources at Weill Cornell Medical College as well as the participation of diverse professionals, patients, and communities accessible from its New York City campuses. I will conduct research during the award period that will have three aims: (1) To adapt cognitive- behavioral exposure therapy (ET) for use with older adults with disabling anxiety-full posttraumatic stress disorder (PTSD), subsyndromal PTSD, or specific phobia (fear of falling) resulting from a fall. The ET will consist of eight sessions incorporating psychoeducation, relaxation training, cognitive restructuring, behavioral activation, and exposure. Modifications will include delivering the treatment at home and encouraging healthy behaviors (communication with healthcare professionals, strengthening social support, engaging in valued activities, and practicing falls prevention); (2) To conduct an open-treatment feasibility trial of ET with this population. Potential participants (recruited via the Division of Critical Care and Trauma) will complete a baseline assessment within three months of returning home from the hospital. Eligible participants who provide informed consent (N = 32) will receive the ET and be re-assessed upon completion of treatment and at three month follow-up. I will evaluate the a) availability of participants, b) enrollment and retention, c) acceptability of the treatment, and 4) the impact of the intervention on diagnosis, symptoms, and quality of life; (3) To conduct a randomized controlled pilot test of the ET. Eligible participants who provide informed consent (N = 64) will be randomized to either ET or a control condition (Relaxation Training) following similar procedures. This study will provide an opportunity to understand three further elements: a) the feasibility of randomization, b) feasibility of the control condition, and c) explore the primary efficacy of the ET. The proposed program will culminate in an application to fund a fully randomized controlled trial. This will be the first trial of ET for older adults with disabling anxiety resulting from a fall. PUBLIC HEALTH RELEVANCE: Although several effective treatments for posttraumatic stress and specific phobia exist, little work has been done to apply these to the needs of older adults, especially those injured by accidents such as falls. This career award will enable me to pursue a program of coursework, mentorship, and research that will allow me to make a significant contribution to this issue. During the award period, I will conduct adapt an evidence-based treatment to make it suitable for older adults with disabling anxiety as a result of being injured by a fall, test the feasibility of the treatment on approximately 96 older patient, and refine both the treatment and research approach in readiness for more intensive study of the treatment's efficacy with a larger sample of patients.

描述（由申请人提供）：“因瀑布受伤的老年人焦虑的干预措施。每年，数以百万计的老年人因跌倒而对生命或严重伤害构成威胁。尽管对堕落的心理后果的认识越来越多，但创伤知识的进步尚未应用于该人群。我的四个培训目标将是：（1）加深我对可能使老年患者治疗复杂的因素的理解； （2）扩大我对老年患者身体康复过程的熟悉； （3）增强我在为老年患者开发干预措施中整合心理药理知识的能力； （4）获取设计临床干预功效的研究所需的技能和数据。拟议的课程计划，与内部和外部顾问的会议以及研究将在Joann Difede博士的指导下完成，并将完成M.P.H. M.P.H.的Martha Bruce博士。我将在威尔·康奈尔医学院（Weill Cornell Medical College）使用机构资源，以及可以从其纽约市校园获得的不同专业人员，患者和社区的参与。我将在奖励期间进行三个目标的研究：（1）适应认知行为暴露疗法（ET），以与患有残疾焦虑症的焦虑症发生后压力障碍（PTSD），次瘤PTSD或特定的phobia（害怕跌倒）的老年人一起使用。 ET将由八个会议组成，其中包括心理教育，放松训练，认知重组，行为激活和暴露。修改将包括在家中提供治疗并鼓励健康的行为（与医疗保健专业人员的沟通，加强社会支持，参与有价值的活动以及预防瀑布）； （2）与该人群进行ET的开放治疗可行性试验。潜在的参与者（通过重症监护和创伤部招募）将在从医院回家后三个月内完成基线评估。提供知情同意的合格参与者（n = 32）将获得ET，并在完成治疗后和三个月随访后重新评估。我将评估a）参与者的可用性，b）入学和保留率，c）治疗的可接受性，以及4）干预对诊断，症状和生活质量的影响； （3）进行ET的随机对照试验测试。提供知情同意的合格参与者（n = 64）将按照类似的程序随机分配到ET或对照条件（放松训练）。这项研究将提供一个理解三个进一步要素的机会：a）随机性的可行性，b）控制条件的可行性，c）探索ET的主要功效。拟议的计划将在申请中达到高潮，以资助完全随机的对照试验。这将是ET的第一次试验，对于因跌倒而导致焦虑的老年人。 公共卫生相关性：尽管存在一些有效的创伤后压力和特定恐惧症的有效治疗方法，但几乎没有工作将其应用于老年人的需求，尤其是那些因跌倒等事故而受伤的人的需求。该职业奖将使我能够遵循课程，指导和研究计划，使我能够为这个问题做出重大贡献。在奖励期间，我将进行适应基于证据的治疗，以使其适用于由于跌倒而受伤的老年人，测试对大约96名老年患者的治疗的可行性，并在治疗方法和研究方法方面进行了准备，以便对治疗方法进行更深入的研究，以对治疗的疗效进行更大的患者样本。