Aggression Prevention Training for Caregivers of Persons with Dementia

痴呆症患者照顾者的攻击预防培训

基本信息

批准号：
8754367
负责人：
Mark E. Kunik
金额：
$ 55.91万
依托单位：
BAYLOR COLLEGE OF MEDICINE
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：
2014-09-03 至 2019-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8754367
关键词：
Active Learning Address Aggressive behavior Antipsychotic Agents Behavioral Biological Factors Books Boxing Caregiver Burden Caregivers Caring Communication Communities Cox Proportional Hazards Models Data Analyses Dementia Development Discipline of Nursing Education Educational Materials Exhibits Family Caregiver Frequencies Funding Health Home environment Incidence Individual Injury Institutionalization Intervention Lead Longitudinal Studies Measures Mental Depression Modeling Morbidity - disease rate Multimedia Outcome Pain Patients Persons Pharmaceutical Preparations Play Prevalence Prevention strategy Preventive Primary Health Care Problem behavior Provider Psychological Factors Randomized Randomized Controlled Trials Recruitment Activity Risk Risk Factors Role Social support Symptoms Telephone aggression prevention base biopsychosocial caregiver education caregiving depressive symptoms design evidence base improved innovation loved ones meetings mortality prevent psychologic public health relevance skills skills training statistics tool

项目摘要

DESCRIPTION (provided by applicant): Caregivers of persons with dementia (PWD) are often responsible for their loved one's daily care coordination and provision. Eighty percent of PWD have behavioral or psychological disturbances, including 40% that are aggressive behaviors. Aggressive behaviors are perhaps the most problematic disturbances because they lead to increased institutionalization, injuries, and use of antipsychotic medications; yet few interventions for aggressive behavior are available. Innovative preventive approaches are urgently needed to replace the use of tranquilizing medications because of their associated increased mortality and morbidity in PWD. The prevalence of pain in PWD is about 60%, and it is a strong predictor of aggression. The biopsychosocial model of pain posits that pain is bidirectionally related to psychological factors (ie, depression) and social support factors (i.e., quality of caregiver/PWD relationship) in addition to biological factors. Thus, depression and quality of the caregiver/PWD relationship can be seen as pain-related features. Caregivers are ideally suited to help address pain, depression, and the caregiver/PWD relationship, thus preventing the development of aggression; but they need tools to assist them in identifying and managing these symptoms. The objectives of this proposal are to assess whether this caregiver intervention, Aggression Prevention Training for Caregivers of Individuals with Dementia (APT), 1) decreases incidence of aggression, 2) decreases aggression-related outcomes (nursing-home placement, caregiver burden, positive aspects of caregiving, and behavior problems), and 3) decreases pain and pain-related features (depression, caregiver/PWD relationship difficulties). This 5-year randomized controlled trial based on the Unmet Needs Model will focus on preventing aggression in PWD with pain and pain-related features by providing the caregiver with targeted education and skill training. PWD and their caregivers will be randomized to APT or to an enhanced usual primary care condition (EU-PC). APT will use active learning tools, including didactics, role- playing, and multimedia (eg, books and DVDs) to educate and provide skill training for the caregiver. The 6-8 modules in the intervention will include 4 core modules that address 4 main aggression risk factors: a) recognizing pain, b) treating pain, c) increasing pleasant activities, and d) improving patient-caregiver communication. Caregivers can select 2 to 3 additional elective sessions; elective selection is guided by the needs of the dyad to further enhance skills related to these core topics. EU-PC provides the patient and caregiver educational materials on pain, notifies the primary care provider of the PWD's level of pain and depression, and provides 8 weekly supportive telephone calls to caregivers. PWD and caregiver outcomes will be collected at baseline, 3, 6 and 12 months. Data analysis will include both univariate descriptive statistics and inferential statistics, including regression models, repeated measure modeling and Cox proportional hazards models.

描述（由申请人提供）：痴呆症患者 (PWD) 的护理人员通常负责其亲人的日常护理协调和提供。 80% 的残疾人存在行为或心理障碍，其中 40% 存在攻击性行为。攻击性行为可能是最成问题的障碍，因为它们会导致收容、伤害和抗精神病药物的使用增加；然而针对攻击性行为的干预措施却很少。迫切需要创新的预防方法来取代镇静药物的使用，因为镇静药物会增加残疾人的死亡率和发病率。残疾人中疼痛的发生率约为 60%，它是攻击性的强烈预测因素。疼痛的生物心理社会模型认为疼痛与心理因素（即抑郁）和社会支持因素（即除了生物因素之外，照顾者/残疾人关系的质量）。因此，抑郁症和照顾者/残疾人关系的质量可以被视为与疼痛相关的特征。护理人员非常适合帮助解决疼痛、抑郁以及护理人员/残疾人关系，从而防止攻击行为的发展；但他们需要工具来帮助他们识别和管理这些症状。本提案的目标是评估这种护理人员干预措施（针对痴呆症患者护理人员的攻击预防培训 (APT)）是否能够 1) 降低攻击行为的发生率，2) 减少与攻击行为相关的结果（疗养院安置、护理人员负担、积极护理方面和行为问题），3）减少疼痛和疼痛相关特征（抑郁、护理者/残疾人关系困难）。这项基于未满足需求模型的为期 5 年的随机对照试验将重点通过为护理人员提供有针对性的教育和技能培训来预防具有疼痛和疼痛相关特征的残疾人的攻击性。残疾人及其护理人员将被随机分配至 APT 或增强型常规初级保健条件 (EU-PC)。 APT 将使用主动学习工具，包括教学、角色扮演和多媒体（例如书籍和 DVD）来教育护理人员并提供技能培训。干预中的 6-8 个模块将包括 4 个核心模块，解决 4 个主要的攻击性风险因素：a) 识别疼痛，b) 治疗疼痛，c) 增加愉快的活动，以及 d) 改善患者与护理人员的沟通。护理人员可以选择 2 至 3 个额外的选修课程；选修课的选择以两人的需求为指导，以进一步提高与这些核心主题相关的技能。 EU-PC 向患者和护理人员提供有关疼痛的教育材料，向初级保健提供者通报残疾人的疼痛和抑郁程度，并每周为护理人员提供 8 次支持性电话。将在基线、3、6 和 12 个月收集 PWD 和护理人员的结果。数据分析将包括单变量描述性统计和推论统计，包括回归模型、重复测量模型和 Cox 比例风险模型。