Apathy in Nursing Home Residents with Dementia: Impact of Caregiver Communication

患有痴呆症的疗养院居民的冷漠：护理人员沟通的影响

• 批准号: 9993187
• 负责人: Ying-Ling Jao
• 金额: $ 19.42万
• 依托单位: PENNSYLVANIA STATE UNIVERSITY, THE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-15 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9993187
• 关键词: Address; Affective; Alzheimer' s Disease; Alzheimer' s disease related dementia; Behavior; Behavioral Symptoms; Caregivers; Caring; Characteristics; Clinical Trials; Code; Communication; Data; Data Set; Dementia; Emotional; Environment; Environmental Risk Factor; Funding; Goals; Health; Impaired cognition; Individual; Intervention; Kale - dietary; Lead; Linear Models; Measures; Mental Depression; Modeling; Moods; Motivation; Nerve Degeneration; Neurobehavioral Manifestations; Nonverbal Communication; Nursing Homes; Outcome; Patients; Pattern; Persons; Quality of Care; Quality of life; Self Care; Services; Severities; Symptoms; Testing; Time; Training; United States National Institutes of Health; Variant; base; dementia care; experience; functional decline; improved; innovation; interest; mortality; neuropsychiatric symptom; person centered; pleasure; routine care; secondary analysis; social

ABSTRACT Apathy is a symptom that presents with a deficit of motivation, reduced goal-directed behaviors and responsiveness to environmental stimulation, and a flat mood. Nearly 50% of nursing home (NH) residents live with Alzheimer’s disease and related dementias (ADRD) and 84% of NH residents with ADRD demonstrate apathy. Apathy is a significant problem because it is associated with considerable negative outcomes, including accelerated cognitive and functional decline, lower quality of life, poorer illness outcomes, greater need for institutional care, and higher mortality. Caregiver-resident communication is fundamental for daily care activities in NHs and significantly impacts quality of care. Interacting with residents with ADRD can be challenging, due to their difficulty in understanding, remembering, and verbally expressing themselves. Interacting with residents with ADRD and apathy is especially challenging, because they are socially withdrawn, do not take initiative, and rely on others’ prompts to engage in interactions. Interventions to improve caregiver communication and person-centered activities have been shown to reduce some behavioral symptoms in ADRD. It is unclear to what extent that apathy symptoms differ over time for the same individual and across different individuals. This information will help to clarify the potential extent to which apathy can be changed. This proposed study will address this gap by analyzing variations in the magnitude and duration of apathy symptoms within and between individuals. Further, it is unknown how caregiver communication impacts apathy. Thus, this study will examine the impact of caregiver communication on apathy. This is a secondary analysis using existing video data from a completed NIH-funded clinical trial. The dataset comprises video observations from 46 residents during caregiver-resident interactions in 12 NHs. Videos were recorded during routine care activities at multiple time points over 5-9 months. This study aims to examine variations in the magnitude and duration of apathy symptoms and examine the concurrent and sequential relationships between caregiver communication and apathy symptoms. First, we will test variations of apathy pattern across residents, within the same resident across interactions, and within each interaction. Next, we will analyze four aspects of caregiver communication qualities: 1) communication topic, 2) emotional tone, 3) person-centered verbal communication, and 4) person-centered non-verbal communication. We anticipate that person-centered communication approaches will be associated with lower levels of apathy symptoms. This is the first study examining the impact of caregiver communication on apathy. Findings will help identify approaches to improve caregiver communication, which can be used to develop interventions to reduce apathy, improve resident health outcomes, quality of life, and reduce mortality for NH residents with ADRD. This study will help promote care quality and efficiency for ADRD and achieve the major goal of the 2017 National Plan to Address Alzheimer’s Disease.

抽象的 冷漠是一种症状，表现为缺乏动力、目标导向行为减少和 近 50% 的疗养院 (NH) 居民生活在对环境刺激反应迟钝、情绪低落的状态。 患有阿尔茨海默病和相关痴呆症 (ADRD)，并且 84% 的新罕布什尔州居民患有 ADRD 冷漠是一个严重的问题，因为它与相当大的负面结果有关， 包括加速认知和功能衰退、生活质量下降、疾病结果较差、 机构护理的需求以及较高的死亡率 护理人员与居民之间的沟通是日常护理的基础。 NH 中的活动并显着影响护理质量。 由于他们在理解、记忆和口头表达方面存在困难，因此具有挑战性。 与患有 ADRD 和冷漠的居民互动尤其具有挑战性，因为他们在社交方面 性格孤僻，不主动，依靠他人的提示进行干预来改善。 护理人员的沟通和以人为本的活动已被证明可以减少一些行为 目前尚不清楚同一个人的冷漠症状随时间的变化有多大。 这些信息将有助于阐明冷漠的潜在程度。 这项拟议的研究将通过分析影响程度和持续时间的变化来解决这一差距。 此外，尚不清楚个体内部和个体之间的冷漠症状。 因此，本研究将探讨照顾者沟通对冷漠的影响。 使用来自 NIH 资助的已完成临床试验的现有视频数据进行分析 该数据集包含视频。 期间录制了 12 个 NH 中 46 名居民在护理人员与居民互动过程中的观察结果。 本研究旨在检查 5-9 个月内多个时间点的日常护理活动。 冷漠症状的严重程度和持续时间，并检查并发和顺序关系 首先，我们将测试护理人员沟通与冷漠症状之间的差异。 居民、同一居民内的交互以及每次交互内接下来，我们将分析四种。 照顾者沟通质量的各个方面：1) 沟通主题，2) 情绪基调，3) 以人为本 言语沟通，以及 4）以人为中心的非言语沟通 我们期望以人为中心。 沟通方式与较低水平的冷漠症状相关。这是第一项研究。 研究护理人员沟通对冷漠的影响的研究结果将有助于确定改善的方法。 护理人员沟通，可用于制定干预措施，减少冷漠，改善居民 这项研究将有助于促进患有 ADRD 的新罕布什尔州居民的健康结果、生活质量和降低死亡率。 提高 ADRD 护理质量和效率，实现 2017 年国家解决方案的主要目标 阿尔茨海默病。