Resident-to-Resident Elder Mistreatment Intervention for Dementia Care in Assisted Living

辅助生活中痴呆症护理中居民对居民虐待老人的干预措施

基本信息

批准号：
9977774
负责人：
MARK STEVEN LACHS
金额：
$ 74.3万
依托单位：
HEBREW HOME FOR THE AGED AT RIVERDALE
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-15 至 2022-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9977774
关键词：
Accidents Activities of Daily Living Address Affective Aggressive behavior Aging Alzheimer&apos s Disease Alzheimer&apos s disease related dementia Area Assisted Living Facilities Awareness Behavior Behavior Disorders Behavioral Caring Characteristics Cluster randomized trial Data Data Reporting Dementia Discipline of Nursing Disease Distress Doctor of Philosophy Educational Intervention Elder Abuse Elderly Experimental Designs Focus Groups Frequencies Geriatrics Gerontology Goals Impaired cognition Individual Injury Intervention Interview Knowledge Living Arrangement Long-Term Care Measurement Measures Mediating Methodology Minority Movement Nursing Homes Outcome Personal Satisfaction Persons Positioning Attribute Prevalence Study Problem behavior Process Professional Role Public Health Publishing Quality of Care Quality of life Randomized Reporting Research Risk Role Safety Services Source Support System Testing Time Training Treatment Effectiveness Vulnerable Populations care systems case finding community setting comorbidity compare effectiveness comparison group dementia care falls group intervention improved informant innovation intervention program multidisciplinary pragmatic trial prevent prospective psychologic psychological distress rapid growth residence response social staff intervention statistics treatment as usual trend

项目摘要

This application proposes a cluster randomized trial to evaluate an innovative staff intervention targeting resident-to-resident elder mistreatment (R-REM) in 6 intervention and 6 control assisted living residences (ALRs). Data will be collected at baseline, 6- and 12-months. We define R-REM as negative and aggressive physical, sexual, or verbal interactions between residents, that in a community setting would likely be construed as unwelcome and have high potential to cause physical and/or psychological distress. R-REM is a serious behavioral problem that has a negative impact on the quality-of-life and physical well-being of residents with and without Alzheimer’s disease and related dementias living in congregate settings. The applicant team is uniquely positioned to conduct this project because of its expertise, multidisciplinary composition, and its previous successful collaborative efforts. Aim 1 (A1). Enhance staff knowledge of R-REM Aim 2 (A2). Enhance staff recognition, reporting and care planning related to R-REM Aim 3 (A3). Evaluate the impact of the staff intervention on resident falls, accidents and injuries and on quality of life using a prospective experimental design that derives information from five sources: (1) Resident interviews (2) Staff informants (3) Observational data (4) Chart and (5) Incident/accident report data. Primary Hypothesis: The frequency of falls, accidents and injuries will decrease in the intervention group, relative to the comparison group after implementation of the training intervention. Secondary Hypotheses: 1. Resident quality-of-life as measured by affective state will improve in the intervention group, relative to the comparison group after implementation of the training intervention. 2. Resident behavior problems will decline in the intervention group, relative to the comparison group after implementation of the training intervention. Resident behaviors will mediate the relationship between the intervention and the falls/accidents/injuries outcome. R-REM has been identified as an important problem in long-term care settings, and our earlier studies identified significant behavioral problems in these settings. However, to our knowledge no interventions targeted at staff have been proposed or tested. The proposed trial is thus timely and innovative. The results are likely applicable to the over 1.2 million residents of AL facilities. With the expected rapid growth in ALRs, and the growing trend to include residents with significant care needs and dementia-related behaviors, the project will serve an important role in improving the quality of care provided by staff.

该申请提出了一项整群随机试验来评估创新的员工干预目标 6 个干预住宅和 6 个对照辅助生活住宅中的居民对居民虐待老人 (R-REM) （ALR）。我们将 R-REM 定义为消极和激进。居民之间的身体、性或言语互动，在社区环境中可能是被认为是不受欢迎的并且很可能导致身体和/或心理困扰的快速眼动睡眠。对居民的生活质量和身体健康产生负面影响的严重行为问题居住在聚集环境中的患有或不患有阿尔茨海默病和相关痴呆症的申请人团队。由于其专业知识、多学科组成以及其之前成功的合作努力。目标 1 (A1)。增强员工的 R-REM 知识。目标 2 (A2)。增强员工对 R-REM 的认识、报告和护理规划。目标 3 (A3) 评估工作人员干预对居民跌倒、事故和伤害以及质量的影响。使用前瞻性实验设计来了解生活，该设计从五个来源获取信息：（1）居民访谈 (2) 工作人员信息提供者 (3) 观察数据 (4) 图表和 (5) 事件/事故报告数据。主要假设：干预后跌倒、事故和受伤的频率将会减少组，相对于实施培训干预后的对照组。次要假设： 1. 以情感状态衡量的居民生活质量将在干预组相对于实施培训干预后的对照组。 2. 相对于对照组，干预组的居民行为问题会有所下降实施培训干预后，居民行为将调节这种关系。干预与跌倒/事故/伤害结果之间的关系。 R-REM 已被认为是长期护理环境中的一个重要问题，我们早期的研究在这些环境中发现了重大的行为问题，但据我们所知，没有采取任何干预措施。因此，针对工作人员提出的试验是及时且具有创新性的。随着 ALR 的预期快速增长，可能适用于 AL 设施中超过 120 万居民。以及将具有重大护理需求和痴呆相关行为的居民纳入其中的日益增长的趋势，该项目将在提高工作人员提供的护理质量方面发挥重要作用。