Reducing Disability via a Family-centered Intervention for Acutely-ill Persons with Alzheimer's Disease and Related Dementias

通过以家庭为中心的干预措施减少患有阿尔茨海默病和相关痴呆症的急性患者的残疾

• 批准号: 9330526
• 负责人: Marie Boltz
• 金额: $ 61.24万
• 依托单位: PENNSYLVANIA STATE UNIVERSITY, THE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-01 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9330526
• 关键词: Abate; Accident and Emergency department; Acute; Address; Admission activity; Advocate; Aging; Alzheimer' s Disease; Area; Attention; Attitude; Caregiver Burden; Caregivers; Caring; Clinical dementia rating scale; Cluster randomized trial; Cognitive; Communities; Cost Savings; Decision Making; Decubitus ulcer; Delirium; Dementia; Dependency; Education; Effectiveness; Elderly; Environment; Environmental Policy; Evaluation; Family; Family Caregiver; Family member; Formal caregiver; Friends; Goals; Health Care Costs; Healthcare; Home Nursing Care; Home environment; Hospital Units; Hospitalization; Hospitals; Impaired cognition; Incontinence; Individual; Intervention; Intrinsic factor; Knowledge; Length of Stay; Lifting; Long-Term Care; Malnutrition; Measures; Medical; Mental Depression; Mentors; Modeling; Modification; Moods; Morbidity - disease rate; Motivation; Nurses; Nursing Staff; Outcome; Pathway interactions; Patient-Focused Outcomes; Patients; Performance; Persons; Physical Function; Physical activity; Play; Policies; Process; Quality of life; Randomized; Readiness; Recovery of Function; Research; Research Personnel; Risk; Role; Sampling; Science; Series; Severities; Stress; Time; Voice; Walking; Work; base; behavior change; care delivery; caregiver strain; caregiving; clinically significant; cost; dementia care; disability; efficacy testing; efficacy trial; empowerment; experience; falls; functional decline; functional outcomes; health care service utilization; hospital readmission; improved; mortality; neuropsychiatric symptom; nursing home length of stay; peer; preference; prevent; programs; randomized trial; relative cost; shared decision making; social

Abstract Older persons with Alzheimer’s disease and related dementias (ADRD) are about two times as likely to be hospitalized as their peers who are cognitively healthy. The care of hospitalized persons with ADRD has traditionally focused on the acute medical problem that led to admission with little attention paid to functional recovery. Older persons with ADRD are at greater risk for functional decline and increased care dependency after discharge due to a combination of intrinsic factors, environmental, policy, and care practices that restrict physical and cognitive activity, and limited staff knowledge of dementia care. Family caregivers (CGs) can play an important role in promoting the functional recovery of hospitalized older adults. They can provide vital information, offer motivation and support of function-focused care, and assume responsibility in varying degrees for post-acute care delivery and coordination. Family- centered FFC (Fam-FFC) incorporates an educational empowerment model for family CGs provided within a social-ecological in-patient framework promoting specialized care to patients with ADRD. The intervention creates an “enabling” milieu for the person with ADRD through environmental and policy assessment/modification, staff education, unit-based champions, and individualized goal setting that focuses on functional recovery. In this patient/family-centered care approach, nurses purposefully engage family CGs in the assessment, decision-making, care delivery and evaluation of function- focused care during hospitalization and the 60-day post-acute period. In the proposed project, we will implement Fam-FFC in a cluster randomized trial of 438 patient/CG dyads in six hospital units randomized within three hospitals (73 dyads per unit) to accomplish the following aims: Aim 1: Validate the efficacy of Fam-FFC on physical function (ADLs/ performance and physical activity), delirium occurrence and severity, neuropsychiatric symptoms, and mood; Aim 2: Evaluate the impact of Fam- FFC on family CG-centered outcomes (preparedness for caregiving, strain, burden, and desire to institutionalize); and Aim 3: Evaluate the relative costs for Fam-FFC v. control condition, and calculate health care cost (post-acute health care utilization) and total cost savings for Fam-FFC. Dyads will be composed of community-residing, hospitalized medical patients with very mild to moderate dementia (0.5 to 2.0 on the Clinical Dementia Rating Scale) and their CG (defined as the primary person providing oversight and support on an ongoing basis). Outcomes will be evaluated at hospital admission, discharge, two and six months post-discharge. This study will be a critical next step in delineating how to partner with family CGs to change acute care approaches provided to patients with ADRD so as to optimize function after discharge, and promote delirium abatement and well-being in these individuals. The societal implications of helping older individuals with Alzheimer’s disease and related dementias avoid functional decline are enormous in terms of aging in place, quality of life, cost, and caregiver burden. The study findings will be relevant for other areas of behavior change research in acute care, specifically those related to engaging patients and families in health care planning, delivery, and evaluation.

抽象的 患有阿尔茨海默病和相关痴呆症 (ADRD) 的老年人大约是老年人的两倍 与认知健康的同龄人一样住院治疗 ADRD 住院患者。 传统上关注的是导致入院的急性医疗问题，而很少关注 患有 ADRD 的老年人功能衰退和增加的风险更大。 由于内在因素、环境、政策和因素的综合作用，出院后的护理依赖 护理实践限制了身体和认知活动，并且工作人员对痴呆症护理的了解有限。 家庭照顾者（CG）在促进住院功能恢复方面可以发挥重要作用 他们可以提供重要信息，提供以功能为中心的护理的动力和支持， 并不同程度地承担急性期后护理的提供和协调责任。 以FFC（Fam-FFC）为中心，结合了家庭CG的教育赋权模式 在社会生态住院框架内促进对 ADRD 患者的专门护理。 干预通过环境和政策为 ADRD 患者创造“有利”环境 评估/修改、员工教育、单位冠军和个性化目标设定 在这种以患者/家庭为中心的护理方法中，护士有目的地关注功能恢复。 让家庭CG参与评估、决策、护理提供和功能评价—— 在拟议的项目中，我们将在住院期间和急性期后 60 天进行重点护理。 在 6 个医院单位的 438 名患者/CG 双人组的整群随机试验中实施 Fam-FFC 在三家医院（每个单位 73 个二元组）中随机分配，以实现以下目标： 目标 1：验证 Fam-FFC 对身体功能（ADL/表现和身体活动）、谵妄的功效 发生率和严重程度、神经精神症状和情绪；目标 2：评估 Fam- 的影响； FFC 关于以家庭 CG 为中心的结果（对照顾、压力、负担和渴望的准备） 目标 3：评估 Fam-FFC 与控制条件的相对成本，并计算 Fam-FFC 的医疗保健成本（急性后医疗保健利用）和总成本节省将为： 由患有极轻度至中度痴呆症的社区住院患者组成 （临床痴呆评定量表为 0.5 至 2.0）及其 CG（定义为提供 持续的监督和支持）将在入院时进行评估， 出院后两个月和六个月这项研究将是描述如何进行的关键下一步。 与家庭 CG 合作，改变为 ADRD 患者提供的急性护理方法，以便 优化出院后的功能，促进这些人谵妄的减轻和福祉。 帮助患有阿尔茨海默病和相关痴呆症的老年人的社会影响 避免功能衰退在就地老龄化、生活质量、成本和护理人员方面是巨大的 研究结果将与急性护理中的行为改变研究的其他领域相关。 特别是那些与让患者和家庭参与医疗保健规划、提供和 评估。