OPTIMIZING DEMENTIA OUTCOMES IN THE COMMUNITY

优化社区痴呆症治疗结果

• 批准号: 8398848
• 负责人: Michelle M. Hilgeman
• 金额: --
• 依托单位: TUSCALOOSA VETERANS AFFAIRS MEDICAL CTR
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-01-01 至 2014-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8398848
• 关键词: Activities of Daily Living; Address; Aggressive behavior; Aging; Alabama; Alzheimer' s Disease; American; Area; Behavioral; Biomedical Research; Caregivers; Caring; Clinical Investigator; Clinical Research; Clinical Trials Design; Cognitive; Cognitive deficits; Communication; Communities; Coping Skills; Data; Dementia; Development; Diagnosis; Diagnostic; Diagnostics Research; Disease; Distress; Doctor of Philosophy; Effectiveness; Elderly; Enrollment; Environment; Family; Family member; Future; Goals; Health; Health Services Accessibility; Healthcare; Home environment; Impaired cognition; Individual; Inpatients; Institutionalization; Intervention; Intervention Studies; Interview; Knowledge; Life; Link; Maintenance; Medical; Medical center; Mental Health; Mentors; Mentorship; Methods; Modeling; Modification; Molds; National Institute on Aging; Outcome; Pain; Persons; Phase; Physical Function; Pilot Projects; Population; Prevention Research; Process; Quality of life; Randomized Controlled Trials; Recording of previous events; Recovery; Rehabilitation Research; Rehabilitation therapy; Research; Research Infrastructure; Research Personnel; Resources; Risk; Rural; Rural Community; Rural Health; Rural Population; Services; Snow; Social Interaction; Staging; Structure; Support System; Technology; Telemedicine; Telephone; Time; TimeLine; Training; United States; Universities; Veterans; Work; aggression prevention; base; career; career development; cognitive function; cognitive rehabilitation; design; early experience; efficacy testing; evidence base; experience; functional decline; interest; medical specialties; mental function; mild cognitive impairment; multi-component intervention; patient oriented; primary outcome; programs; psychoeducational intervention; psychosocial; rehabilitation science; research and development; rural area; skills; social; therapy development

DESCRIPTION Optimizing Dementia Outcomes in the Community Anticipated Impacts: This goal of this career development proposal is to acquire the knowledge, skills and experience necessary to champion a rehabilitation-focused research agenda that will establish optimal interventions for promoting functioning, treating indicators of distress, and maintaining meaningful interpersonal engagement that impacts quality of life and basic daily living activities in the early and moderate stages of dementia. A primary aim of the proposed work is to understand the scope of the unmet needs of a cognitively impaired veteran population in a rural setting and to identify optimal dyadic (veteran/caregiver) approaches for intervention. A pilot telephone-based rehabilitative intervention will be developed. The impact of this work will be realized when an efficacious and highly-accessible rehabilitation intervention, such as the telephone-based psychoeducational intervention being piloted, becomes available. Background: Over 5.4 million individuals in the US are diagnosed with related dementing disorders. Determining optimal community-based interventions to maintain veterans at home rather than inpatient facilities should be at the forefront of dementia planning strategies. Traditional psychosocial and psychoeducational interventions that target increasing caregiver skills and coping need to be paired with patient-centered rehabilitation-focused modules for the individuals with early and moderate stages of dementia to promote optimal functioning that will impact quality of life through increased physical independence, social engagement, reduced pain/distress, and maintenance of abilities and identity into the later stages of the disease. Yet, existing skill-basd interventions take an either/or approach - focusing on the needs of either the individual with dementia or the family member who is providing care. Yet, the social, physical, medical, and mental health needs of these individuals are often intimately linked, and a healthy relationship between these individuals is essential for maintaining care in the home for as long as possible. A recent evidence synthesis concluded that patient-centered multi-component interventions sensitive to the needs of the dyad offer the most promise for effects on diverse outcomes. At particular risk of under recognition and limitations in access to resources are rural-residing veterans. Objectives: 1) To conduct qualitative interviews with veterans and their families who live in rural areas and have been identified on a cognitive screen as experiencing cognitive deficits to determine their perceived needs and gaps in VA rehabilitation and health care supports as it applies to cognitive functioning and rehabilitation; and 2) to modify an evidence-based psychosocial intervention called Preventing Aggression in Veterans with Dementia, for use with veterans and their caregivers to examine the feasibility and necessary infrastructure of conducting this intervention with individuals with dementia and their family support by phone rather than in person as it was originally designed. We anticipate that this modification will increase utilization and access to dementia care in rural veteran populations. Dr. Hilgeman plans to obtain additional training under the mentorship of well-established VA researchers in the following areas: 1) dementia; 2) mixed-methods intervention development and clinical trial design; 3) rehabilitation science and interventions; and 4) rural health and telemedicine technologies. The primary outcomes will be qualitative themes generated from interviews with veterans about perceived needs as well as preliminary quantitative and qualitative data addressing the feasibility and likely outcomes of the modified phone-based intervention. PUBLIC HEALTH RELEVANCE: "Optimizing Dementia Outcomes in the Community" is a timely career development proposal given that more individuals with dementia will seek services from the VA over the next 10 years than at any point in our nations' history. It is responsive to priority areas of the Office of Research Development and the Rehabilitation R&D Service. The application is a pilot study and training plan that will prepare Michelle Hilgeman, Ph.D. for a career addressing translatable rehabilitative strategies and interventions that increase management of rurally- residing veterans with dementias across the continuum of the disease to increase communication, identify and manage pain, increase engagement in meaningful social interactions, and ultimately delay institutionalization through family-centered behavioral and psychosocial interventions. Defining optimal rehabilitation and recovery outcomes for aging veterans in the home is an important contribution for community-dwelling aging veterans and their families, particularly in rural communities with diminished access to specialty health care resources.

描述 优化社区中的痴呆症结果预期的影响：这项职业发展建议的目标是获得以康复为重点的研究议程来获得所必需的知识，技能和经验，该研究议程将建立最佳的干预措施，以促进运作，治疗困扰指标，并维持有意义的人际关系，以影响有意义的人际关系，以影响生活和基本的日常生活和基本的早期生活活动，并在早期和基础上生活。 痴呆症的阶段。拟议工作的主要目的是了解在农村环境中认知受损人口未满足的需求的范围，并确定最佳的二元/护理人员（退伍军人/看护者）的干预方法。将开发基于电话的康复干预措施。当可以进行有效且高度访问的康复干预措施（例如基于电话的心理教育干预措施）提供时，将实现这项工作的影响。背景：美国超过540万人被诊断出患有相关痴呆症。确定基于社区的最佳干预措施以维持在家中的退伍军人而不是住院设施，这应该是痴呆症计划策略的最前沿。为了使痴呆症的早期和中等阶段的个人与以患者为中心的康复专注的模块配对，需要与以患者为中心的康复专注的模块配对传统的心理社会和心理教育干预措施，以促进最佳功能，以促进生活质量，从而通过增强身体独立性，社交互动，疼痛/痛苦和疾病的能力和确定性的体育症来促进生活质量，从而影响生活质量。然而，现有的技能-BASD干预采用/或方法 - 专注于痴呆症患者或提供护理的家人的需求。然而，这些人的社会，身体，医疗和心理健康需求通常是密切相关的，这些人之间的健康关系对于尽可能长时间地保持家庭护理至关重要。最近的一个证据综合得出的结论是，以患者为中心的多组分干预措施对二元组的需求敏感为对各种结果的影响提供了最大的希望。承认的尤其风险和获取资源的限制是农村保留的退伍军人。目的：1）对生活在农村地区的退伍军人及其家人进行定性访谈，并在认知屏幕上被确定为经历认知缺陷，以确定其可感知的需求，并在VA康复和卫生保健方面的差距，因为它适用于认知功能和康复； 2）修改一种基于证据的社会心理干预措施，称为预防痴呆症退伍军人的侵略，与退伍军人及其护理人员一起使用，以检查与痴呆症及其家庭支持的人进行这种干预的可行性和必要基础设施，而不是通过电话，而不是最初设计的。我们预计这种修改将增加农村退伍军人人口中的痴呆症护理的利用和访问。希尔格曼博士计划在以下领域良好的VA研究人员的指导下获得额外的培训：1）痴呆症； 2）混合方法干预开发和临床试验设计； 3）康复科学和干预措施； 4）农村健康和远程医疗技术。主要结果将是与退伍军人有关感知需求的访谈以及初步定量和定性数据产生的定性主题，以解决基于电话的干预措施的可行性和可能结果。 公共卫生相关性： “在社区中优化痴呆症的结果”是一项及时的职业发展建议，鉴于在未来10年中，痴呆症患者会从弗吉尼亚州寻求服务，而不是我们各国历史上的任何时刻。它对研究开发办公室和康复研发服务办公室的优先领域有回应。该申请是一项试点研究和培训计划，该计划将准备米歇尔·希尔格曼（Michelle Hilgeman）博士。为了解决可翻译的康复策略和干预措施的职业，以在疾病的连续性中增加对痴呆症的野生退伍军人的管理，以增加沟通，识别和管理疼痛，增加对有意义的社交互动的参与，并最终通过以家庭为中心的行为和心理社会干预来延迟制度化。定义家庭中老化退伍军人的最佳康复和恢复成果是对社区老龄化的退伍军人及其家人的重要贡献，尤其是在获得专业医疗保健资源访问权限的农村社区中。