A Problem Solving Intervention for Post-ICU Cognitive Impairment in Older Adults

针对老年人 ICU 后认知障碍的问题解决干预措施

• 批准号: 9914194
• 负责人: Judith Ann Tate
• 金额: $ 15.6万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-15 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9914194
• 关键词: Academic Medical Centers; Acute; Address; Adherence; Adult; Affective; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Anxiety; Behavior; Blinded; Brain; Cardiovascular system; Cellular Phone; Chronic Disease; Cognitive; Control Groups; Critical Illness; Data; Data Collection; Decision Making; Delirium; Dementia; Development; Disease; Elderly; Electrolytes; Enrollment; Environmental Risk Factor; Goals; Health; Home environment; Hospitals; Impaired cognition; Impairment; Infrastructure; Intensive Care Units; Intervention; Linear Regressions; Liquid substance; Lung; Manuals; Manuscripts; Mechanics; Mediating; Medical; Mental Depression; Modeling; National Institute on Aging; Neurobehavioral Manifestations; Online Systems; Outcome; Participant; Patients; Personal Satisfaction; Persons; Pilot Projects; Prevalence; Problem Solving; Process; Protocols documentation; Quality of life; Randomized; Randomized Controlled Trials; Rehabilitation therapy; Research; Resources; Risk; Sample Size; Science; Self Efficacy; Self Management; Severities; Social support; Structure; Survivors; Syndrome; Technology; Telephone; Testing; Training; Trauma; Traumatic Brain Injury; base; burden of illness; cognitive change; cognitive function; cognitive rehabilitation; comorbidity; dementia risk; design; disability; effective intervention; effectiveness testing; efficacy study; experience; follow-up; functional decline; group intervention; health care service utilization; health related quality of life; intervention effect; operation; physical symptom; post intervention; programs; psychological symptom; recruit; trial comparing; Academic Medical Centers; Acute; Address; Adherence; Adult; Affective; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Anxiety; Behavior; Blinded; Brain; Cardiovascular system; Cellular Phone; Chronic Disease; Cognitive; Control Groups; Critical Illness; Data; Data Collection; Decision Making; Delirium; Dementia; Development; Disease; Elderly; Electrolytes; Enrollment; Environmental Risk Factor; Goals; Health; Home environment; Hospitals; Impaired cognition; Impairment; Infrastructure; Intensive Care Units; Intervention; Linear Regressions; Liquid substance; Lung; Manuals; Manuscripts; Mechanics; Mediating; Medical; Mental Depression; Modeling; National Institute on Aging; Neurobehavioral Manifestations; Online Systems; Outcome; Participant; Patients; Personal Satisfaction; Persons; Pilot Projects; Prevalence; Problem Solving; Process; Protocols documentation; Quality of life; Randomized; Randomized Controlled Trials; Rehabilitation therapy; Research; Resources; Risk; Sample Size; Science; Self Efficacy; Self Management; Severities; Social support; Structure; Survivors; Syndrome; Technology; Telephone; Testing; Training; Trauma; Traumatic Brain Injury; base; burden of illness; cognitive change; cognitive function; cognitive rehabilitation; comorbidity; dementia risk; design; disability; effective intervention; effectiveness testing; efficacy study; experience; follow-up; functional decline; group intervention; health care service utilization; health related quality of life; intervention effect; operation; physical symptom; post intervention; programs; psychological symptom; recruit; trial comparing

PROJECT SUMMARY At 1-year post-ICU discharge, two-thirds of ICU survivors experience cognitive dysfunction at a severity comparable to that of patients with mild Alzheimer's disease or moderate traumatic brain injury, regardless of age or pre-morbid chronic illness burden. Despite the prevalence, significance and persistence of cognitive impairment following critical illness, few interventions have been tested that help ICU survivors overcome these cognitive changes. The purpose of this pilot study is to evaluate the feasibility, acceptability and efficacy of a problem solving intervention, Post Intensive Care Unit Problem Solving (PIC-UPS) in the home setting for older adult ICU survivors suffering from post-ICU cognitive impairment. This study will employ a small-scale two-group randomized controlled trial (RCT) comparing the effect of a ten session intervention with a Control Group (CG) for older adult ICU survivors who have cognitive impairment at hospital discharge on cognitive function, chronic illness self-management, affective well-being (anxiety, depression), health care utilization and health related quality of life (HR-QoL). The components of PIC-UPS include (1) in-person, in-home strategy training designed to overcome cognitive problems by employing comprehensive structured problem- solving strategies delivered by trained interventionists and (2) concomitant use of smartphone technology specifically designed to remind and reinforce in-person training. The study will be conducted in the adult medical ICUs at a large Midwestern academic medical center with older adult participants (n=80) recruited prior to home discharge and randomized to either intervention or control group. Baseline data collection will occur at enrollment. The first session of PIC-UPS will be delivered after enrollment to those participants randomized to the intervention group n the hospital setting. Weekly intervention sessions (9) will be conducted by a trained interventionist and supplemented by telephone reminders to complete daily homework. Follow- up data collection will be conducted in the home for all participants (intervention and control group) by a blinded data collector three months post-enrollment. This study will provide data on processes critical to further hypothesis development and to the successful development of a large RCT to test the effectiveness of PIC-UPS on cognitive function, chronic illness self- management, affective well-being (anxiety, depression), health care utilization and HR-QoL in older adult ICU survivors who suffer cognitive impairment at hospital discharge. In addition, our pilot will provide infrastructure for a larger trial (e.g., manual of operations, web-based data collection form), a manuscript describing the pilot study findings, and an R01 application to NIA.

项目摘要 ICU后1年，三分之二的ICU幸存者在A处经历认知功能障碍 严重程度可与轻度阿尔茨海默氏病或​​中度外伤患者相当 脑损伤，不论年龄或前慢性疾病负担如何。尽管普遍存在 严重疾病后认知障碍的意义和持久性，几乎没有干预 已经测试了帮助ICU幸存者克服这些认知变化的测试。目的 这项试点研究是为了评估解决问题的可行性，可接受性和功效 干预，重症监护病房解决问题解决方案（PIC-UPS） 老年人ICU幸存者患有ICU后认知障碍。这项研究将采用 小型两组随机对照试验（RCT），比较了十个疗程的效果 与具有认知能力的老年人ICU幸存者的对照组（CG）的干预 医院出院的障碍在认知功能，慢性疾病自我管理方面， 情感幸福感（焦虑，抑郁），医疗保健利用和与健康相关的生活质量 （HR-QOL）。图片的组成部分包括（1）面对面的，在家策略培训 旨在通过采用全面的结构化问题来克服认知问题 - 解决训练有素的干预主义者和（2）智能手机的使用策略 专门设计的技术旨在提醒和加强面对面的培训。该研究将是 在大型中西部学术医学中心的成人医学ICU中进行 成人参与者（n = 80）在出院前招募并随机分配到任何干预措施 或对照组。基线数据收集将在注册时发生。第一个图片会议 入学后将交付给那些随机分配给干预组N的参与者 医院环境。每周干预会议（9）将由训练有素的 干预主义者，并补充电话提醒，以完成日常作业。跟随- UP数据收集将在所有参与者的家庭中进行（干预和控制 小组）在注册后三个月内由盲数据收集器组成。这项研究将提供有关 过程对于进一步的假设发展和成功发展的过程至关重要 大型RCT测试图片对认知功能，慢性疾病自我的有效性 管理，情感福祉（焦虑，抑郁），医疗保健利用和HR-QOL 在出院时遭受认知障碍的老年人ICU幸存者。另外，我们的 飞行员将为大型试验提供基础架构（例如，操作手册，基于Web的数据 收集表），一种描述试点研究结果的手稿，以及对NIA的R01应用。