Testing Dementia Caregiver TeleCoaching to Reduce Episodes of Abuse and Neglect by Recognizing and Managing Care-Resistant Behaviors

测试痴呆症护理人员远程辅导，通过识别和管理抗护理行为来减少虐待和忽视的发生

• 批准号: 10683297
• 负责人: RITA A JABLONSKI
• 金额: $ 70.11万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10683297
• 关键词: Address; Adult; Alzheimer' s Disease; Alzheimer' s disease related dementia; Area; Behavior; Behavioral Symptoms; Caregivers; Caring; Cessation of life; Consultations; Coping Skills; Coupled; Dementia; Dementia caregivers; Distress; Educational Intervention; Educational process of instructing; Elder Abuse; Elderly; Equation; Ethics; Family; Family Caregiver; Frequencies; Frustration; Funding; Guilt; Health; Healthcare Systems; Injury; Internet; Intervention; Intervention Studies; Knowledge; Lead; Learning; Managed Care; Mandatory Reporting; Mental Depression; Methods; Modeling; Oral cavity; Participant; Patient Self-Report; Performance; Personal Satisfaction; Persons; Physical aggression; Problem Solving; Protocols documentation; Qualifying; Quality of Care; Reporting; Research; Research Priority; Resistance; Risk; Risk Factors; Schedule; Scientist; Series; Services; Stress; Surveys; Testing; Time; Training; Translations; Trust; United States National Institutes of Health; United States Preventative Services Task Force; Waiting Lists; Work; abuse neglect; care outcomes; care recipients; caregiver bereavement; caregiver interventions; caregiving; comparison control; coping; design; diaries; disorder prevention; effectiveness testing; efficacy evaluation; efficacy testing; elder neglect; emotional abuse; evidence base; experience; family caregiving; follow-up; group intervention; instrument; intervention effect; online care; oral care; physical abuse; post intervention; practice setting; prevent; programs; randomized, clinical trials; recruit; telecoaching; telehealth

PROJECT ABSTRACT In family caregiving situations, those with Alzheimer’s disease and related dementia (ADRD) are more likely to experience elder abuse and neglect (EAN) than older adults living alone or not requiring assistance with care. Elder abuse and neglect (EAN) is defined as acts committed by a person in a trusted relationship that cause actual or increased risk of harm to an older adults’ health and wellbeing. EAN consists of different subtypes such as physical and psychological abuse and neglect. About half of family caregivers for persons with dementia self- report doing at least one of these three EAN subtypes. This proposal evaluates an evidence-based tele-coaching intervention, Care-Resistant Behavior Internet Training (CuRB-IT) to enhance coping skills of family caregivers and reduce elder abuse and neglect (EAN). CRB includes actions taken by a person with ADRD to resist or refuse assistance with care, such as refusing to open their mouth for oral care or using physical aggression. Our tele-coaching intervention (CuRB-IT), which increases problem-solving coping skills by teaching practical strategies to manage CRBs, effectively reduces CRB-related caregiver distress. We will test the effectiveness of CuRB-IT in a delayed-intervention randomized clinical trial, within a multi-time series approach. Caregivers in immediate- and delayed-intervention groups (N=266) will complete 4 waves of instrument completion and daily diary surveys describing the frequency of CRB and EAN over a 21-day period at baseline, 3 months, 6 months, and 9 months. Delayed-intervention caregivers will receive weekly texts to reduce inflated intervention effects inherent in many wait-list control designs.22 After the 3-month follow-up, the delayed-intervention group will then receive the CuRB-IT intervention. This design allows us to maximize power to examine efficacy (between-group), mechanism-of-action, and intervention delay (within-group). Thus, we propose the following Specific Aims: 1) Test the efficacy of an online care-resistant behavior coaching intervention in reducing frequency of EAN (a) among the experimental (immediate-intervention group) as compared to the control (delayed-intervention group) (between groups) and (b) within-person from pre- to post- intervention.; 2) Test hypothesized mechanism of action through multi-level structural equation modeling to assess the relationships between CRB-stress appraisal, use of CuRB-IT problem-focused coping strategies and EAN; and 3) Examine intervention decay at 3- and 6-months post intervention to determine performance of intervention and inform scheduling of booster sessions. We will also assess the efficacy of the CuRB-IT intervention in preventing onset of EAN use by family caregivers as an exploratory aim. This proposal directly addresses high-priority research gaps identified by the NIH Office of Disease Prevention and US Preventative Task Force. Next steps in this research program will focus on translation to practice settings such as the UAB Health system’s Caregiver Bereavement Service Line and Adult Protective Services.

项目摘要 在家庭护理情况下，患有阿尔茨海默病和相关痴呆症 (ADRD) 的人更有可能 比独居或不需要护理帮助的老年人更容易遭受虐待和忽视（EAN）。 虐待和忽视老年人 (EAN) 的定义是由处于信任关系中的人所实施的导致 对老年人健康和福祉造成实际或增加的风险由不同的亚型组成，例如。 大约一半的痴呆症患者的家庭护理人员会自我虐待和忽视。 报告至少执行这三种 EAN 子类型中的一种 该提案评估了基于证据的远程辅导。 干预、抗护理行为互联网培训 (CuRB-IT)，以提高家庭护理人员的应对技能 减少虐待和忽视老年人 (EAN) 包括 ADRD 患者为抵抗或忽视而采取的行动。 拒绝护理协助，例如拒绝张开嘴进行口腔护理或使用身体攻击。 远程辅导干预 (CuRB-IT)，通过教授实用知识来提高解决问题的技能 管理 CRB 的策略，有效减少 CRB 相关的护理人员痛苦 我们将测试其有效性。 CuRB-IT 在一项延迟干预随机临床试验中，采用多时间系列方法。 立即干预组和延迟干预组（N = 266）将完成 4 轮仪器完成，每天 日记调查描述基线、3 个月、6 个月、21 天期间的 CRB 和 EAN 频率 延迟干预的护理人员将每周收到短信，以减少夸大的干预效果。 许多等待名单控制设计中固有的。22 3 个月的随访后，延迟干预组将 接受 CuRB-IT 干预 这种设计使我们能够最大限度地检查疗效（组间）， 因此，我们提出以下具体目标：1) 测试在线抗护理行为辅导干预在降低 EAN 频率方面的功效 (a) 实验组（立即干预组）与对照组（延迟干预组）相比 （组间）和（b）从干预前到干预后的内部；2）测试突击机制 通过多层次结构方程建模来评估 CRB 压力之间的关系 评估、使用 CuRB-IT 以问题为中心的应对策略和 EAN；以及 3) 检查干预衰减 干预后 3 个月和 6 个月，以确定干预效果并告知加强计划的安排 我们还将评估 CuRB-IT 干预措施在预防家庭使用 EAN 方面的有效性。 该提案直接解决了研究人员确定的高度优先的研究空白。 美国国立卫生研究院疾病预防办公室和美国预防工作组将采取该研究计划的后续步骤。 专注于实践环境的转化，例如 UAB Health 系统的护理人员丧亲服务热线 和成人保护服务。