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 老年人患有阿尔茨海默氏病和相关痴呆症（ADRD）的可能性约为 作为认知健康的同龄人住院。 ADRD住院的人的照顾 传统上，一直集中在导致入院的急性医疗问题上，很少关注 功能恢复。 ADRD的老年人有功能下降和增加的风险 由于内在因素，环境，政策和 限制身体和认知活动的护理实践，以及员工对痴呆症护理的了解有限。 家庭护理人员（CGS）可以在促进住院的功能恢复中发挥重要作用 老年人。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， 并承担不同程度的责任，用于急性后护理和协调。家庭- 集中的FFC（FAM-FFC）纳入了为家庭CGS提供的教育授权模型 在社会生态内科医生的框架内，为ADRD患者促进专业护理。这 干预通过环境和政策为患有ADRD的人创造了一个“启用”环境 评估/修改，员工教育，基于单位的冠军和个性化目标设定 专注于功能恢复。在这种患者/以家庭为中心的护理方法中，护士有意 让家庭CGS参与评估，决策，护理交付和功能评估 - 住院期间和急性后60天的关注护理。在拟议的项目中，我们将 在六个医院单位的438名患者/CG二元组的群集随机试验中实施FAM-FFC 在三家医院（每单位73个二元组）中随机分组以实现以下目的：目标1：验证 FAM-FFC对身体功能的效率（ADL/表现和体育锻炼），ir妄 目标2：评估家族的影响 - FFC在家庭中以CG为中心的结果（准备护理，应变，伯恩和渴望 制度化）； AIM 3：评估Fam-FFC诉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率）和总成本节省。二元组会 由社区住院的医疗患者组成，患有非常轻度至现代化的痴呆症 （临床痴呆率评级量表为0.5至2.0）及其CG（定义为提供的主要人 持续监督和支持）。结果将在入院时进行评估， 放电后两个月和六个月。这项研究将是描述如何描述的关键下一步 与家庭CGS合作，以更改为ADRD患者提供的急性护理方法 优化出院后的功能，并促进这些人的ir妄和福祉。 帮助老年人患有阿尔茨海默氏病和相关痴呆症的社会含义 避免功能下降的衰老，生活质量，成本和照料者 负担。研究结果将与急性护理中其他行为改变研究有关， 特别是与使患者和家庭参与医疗保健计划，分娩以及 评估。