Development and Feasibility of a Behavioral Activation Intervention to Support Independence in Older Veterans at Risk for Functional Decline

行为激活干预措施的开发和可行性，以支持面临功能衰退风险的老年退伍军人的独立性

• 批准号: 10538999
• 负责人: Meaghan A. Kennedy
• 金额: --
• 依托单位: EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-11-01 至 2027-10-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10538999
• 关键词: Activities of Daily Living; Address; Adherence; Admission activity; Age; Aging; Area; Award; Behavioral; Behavioral Model; Behavioral Sciences; Cancer Survivor; Caring; Chronic; Clinical; Clinical Trials Design; Cognition; Cognitive; Communities; Complex; Data; Development; Disease; Education; Elderly; Enrollment; Etiology; Evidence based intervention; Feedback; Funding; Future; Geriatric Psychiatry; Geriatrics; Goals; Grant; Growth; Health; Health care facility; Home; Hospitalization; Impaired cognition; Individual; Intervention; Interview; Leadership; Life; Linear Regressions; Long-Term Care; Manuals; Measures; Mental Depression; Mentors; Methodology; Methods; Mission; Modeling; Occupational Therapist; Occupational Therapy; Outcome; Participant; Physical Function; Physicians; Pilot Projects; Primary Care; Prospective Studies; Protocols documentation; Psychologist; Psychosocial Assessment and Care; Randomized; Rehabilitation therapy; Reporting; Research; Research Personnel; Risk; Role; Rural; Sampling; Social Controls; Social Functioning; Social isolation; Structure; Surveys; Target Populations; Techniques; Testing; Training; United States National Institutes of Health; Veterans; Work; Writing; acute care; adverse outcome; aged; attentional control; behavioral health; behavioral study; brief intervention; career; career development; cognitive function; design; diagnostic strategy; disability; effective intervention; efficacy trial; evidence base; experience; follow-up; functional decline; functional independence; human old age (65+); improved; innovation; mild cognitive impairment; mortality; multiple chronic conditions; novel; pilot test; pilot trial; preservation; primary outcome; programs; psychosocial; recruit; rehabilitation science; satisfaction; social; telehealth; therapy development; trend

Background: Half of all Veterans are aged 65 or older. Age and associated chronic conditions increase risk for functional limitations, defined as difficulty performing day-to-day activities. This is significant not only because older Veterans place a high priority on maintaining function, but also because the manifestation of limitations signifies elevated risk for adverse outcomes. Effective interventions are needed to help older Veterans maintain independence in the community. This project will adapt an empirically-supported psychosocial therapy for depression – behavioral activation (BA) – to promote physical, cognitive, and social functioning in community-dwelling older Veterans at risk for functional decline. As a brief intervention that increases engagement in values-aligned activities, BA is a promising approach to support functioning. Specific Aims and Methods: We will develop and pilot test a six-week telehealth-delivered BA intervention, “Behavioral Activation for Independence in Older Veterans” (ACTIVaTE). The intervention will be designed to increase engagement in meaningful activities in line with individual values. The target population is older Veterans (age ≥65) enrolled in VA primary care who are at risk for functional decline, defined as a score of ≥3 on the Vulnerable Elders Survey (VES-13). This will be accomplished over three aims: Aim 1. Adapt: We will develop ACTIVaTE based on an existing BA model (Brief Behavioral Activation Treatment for Depression-Revised) for delivery to older Veterans at risk for functional decline via VA Video Connect (VVC). Our previous experience with BA will inform the initial adaptation, incorporating perspectives from primary care, geropsychology, and occupational therapy. We will seek feedback on the preliminary manual and participant workbook via semi-structured interviews with VA psychologists (n=5), occupational therapists (n=5), and Veterans (n=5), using findings to further modify the materials. Aim 2. Refine: We will conduct an open trial of ACTIVaTE delivered via VVC in 10 older Veterans at risk for functional decline, using mixed methods to determine preliminary acceptability of the intervention. Further refinements will be made to the intervention based on findings from qualitative interviews and a satisfaction survey using the Theoretical Framework of Acceptability. Aim 3. Test: We will conduct a pilot RCT of ACTIVaTE versus attention control in 48 older Veterans with VES- 13 score ≥3 recruited from primary care. We will collect clinical measures at baseline, 6 weeks, and 12 weeks, using the Ambulatory Measure for Post-Acute Care (AM-PAC) and PROMIS Satisfaction with Social Roles and Activities as primary measures of physical, cognitive, and social functioning. We will also conduct semi- structured interviews with a purposive sample of participants based on satisfaction and adherence. Feasibility will be determined by enrollment and retention and acceptability will be determined by adherence and satisfaction, as well as by themes from qualitative interviews. Preliminary impact on AM-PAC and PROMIS will be explored through within and between groups mixed-effects linear regression models and proportions of participants who achieve minimal clinically important change in outcomes. Impact: This project will adapt an evidence-based intervention for depression (BA) for a novel purpose: promoting functional independence in older Veterans. Through VVC delivery, it has potential for scalability and implications for isolated and rural Veterans. Data will be used to inform the design of a future full-scale efficacy trial (RR&D Merit Award). In parallel with my research aims, I will obtain training in behavioral and rehabilitation science, methodology (clinical trials design and analytic techniques), grant writing and scholarly dissemination, and leadership. While supporting the development of an innovative, values-aligned treatment targeting functioning, this CDA-2 will also promote my growth into an independently-funded VA physician investigator innovating at the interface of primary care, behavioral health, and rehabilitation.

背景：一半的退伍军人年龄在 65 岁或以上。年龄和相关的慢性病会增加风险。 对于功能限制，定义为执行困难的日常活动，这不仅很重要。 因为老年退伍军人高度重视维持功能，而且还因为 需要有效的干预措施来帮助老年人 退伍军人在社区中保持独立性，该项目将采用经验支持的方法。 抑郁症的心理社会疗法 – 行为激活 (BA) – 促进身体、认知和社交能力 作为一种简短的干预措施，可以帮助居住在社区的老年退伍军人面临功能衰退的风险。 BA 增加了对符合价值观的活动的参与，是一种有前景的支持功能的方法。 具体目标和方法：我们将开发并试点测试为期六周的远程医疗提供的 BA 干预措施， “老年退伍军人独立行为激活”(ACTIVaTE) 的干预措施旨在： 增加参与符合个人价值观的有意义的活动 目标人群年龄较大。 参加 VA 初级保健的退伍军人（年龄≥65 岁）有功能衰退风险（定义为评分≥3） 弱势老年人调查（VES-13） 这将通过三个目标来实现： 目标1.适应：我们将基于现有的BA模型（Brief Behavioural Activation 通过 VA 视频向面临功能衰退风险的老年退伍军人提供抑郁症治疗（修订版） Connect (VVC)。我们之前与 BA 的经验将为初步调整提供信息，并纳入观点。 我们将寻求初级保健、老年心理学和职业治疗的反馈。 通过对 VA 心理学家参与者 (n=5) 进行半结构化访谈的手册和工作簿，职业 治疗师 (n=5) 和退伍军人 (n=5)，利用研究结果进一步修改材料。 目标 2. 完善：我们将在 10 名面临以下风险的老年退伍军人中进行通过 VVC 提供的 ACTIVaTE 公开试验 功能下降，使用混合方法来确定干预的初步可接受性。 将根据定性访谈的结果和满意度对干预措施进行改进 使用可接受性理论框架进行调查。 目标 3. 测试：我们将在 48 名患有 VES 的老年退伍军人中进行 ACTIVaTE 与注意力控制的试点随机对照试验 13 从初级保健机构招募得分≥3 的患者，我们将收集基线、6 周和 12 周时的临床测量数据。 使用急性后护理门诊测量 (AM-PAC) 和 PROMIS 对社会角色的满意度，以及 活动作为身体、认知和社会功能的主要衡量标准。我们还将进行半活动。 基于满意度和可行性的有目的样本的结构化访谈。 将由注册和保留决定，可接受性将由遵守和遵守决定 满意度以及定性访谈的主题对 AM-PAC 和 PROMIS 的初步影响。 通过组内和组间混合效应线性回归模型和比例进行探索 在结果上实现最小临床重要变化的参与者。 影响：该项目将采用基于证据的抑郁症干预措施（BA）以实现新的目的： 通过 VVC 交付，促进老年退伍军人的功能独立性，它具有可扩展性和潜力。 对孤立和农村退伍军人的影响将用于为未来全面功效的设计提供信息。 试验（RR&D 优异奖） 在实现我的研究目标的同时，我将接受行为和康复方面的培训。 科学、方法论（临床试验设计和分析技术）、资助写作和学术传播， 同时支持开发创新的、符合价值观的治疗目标。 如果 CDA-2 正常运行，它也将促进我成长为一名独立资助的 VA 医师调查员 在初级保健、行为健康和康复领域进行创新。