Characterizing Alzheimers Disease and Serious Mental Illness Co-Occurrence Among Nursing Home Residents and Relationship to Symptomatology and Care Practices

疗养院居民中阿尔茨海默病和严重精神疾病同时发生的特征及其与症状学和护理实践的关系

• 批准号: 10601879
• 负责人: Laura Marie Block
• 金额: $ 3.85万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10601879
• 关键词: Accounting; Address; Admission activity; Adult; Age; Aging; Alzheimer' s Disease; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Antidepressive Agents; Antipsychotic Agents; Assessment tool; Behavior; Behavioral Symptoms; Bipolar Disorder; Caring; Characteristics; Clinical; Cognitive; Complex; Data; Data Set; Dementia; Development; Diagnosis; Discipline of Nursing; Disease; Disease Progression; Distal; Educational Status; Effectiveness; Elderly; Ethnic Origin; Exhibits; Formal caregiver; Future; Goals; Home Nursing Care; Impaired cognition; Individual; Intervention; Interview; Knowledge; Link; Long-Term Care; Major Depressive Disorder; Managed Care; Methods; Modeling; National Institute on Aging; Nurses; Nursing Homes; Outcome; Pain; Pain management; Pattern; Perception; Persons; Pharmaceutical Preparations; Play; Prevalence; Provider; Psychiatric therapeutic procedure; Public Health; Quality of Care; Quality of life; Race; Research; Research Design; Research Priority; Resources; Risk; Role; Safety; Schizophrenia; Scientist; Shapes; Social Workers; Symptoms; Techniques; Testing; Training; Variant; Vulnerable Populations; adverse outcome; behavioral impairment; burden of illness; career; comorbidity; dementia care; design; disorder risk; experience; falls; functional decline; functional disability; functional status; improved; improved outcome; person centered; programs; psychologic; psychosocial; restraint; severe mental illness; sex; skills; symptom management; symptomatology

PROJECT SUMMARY/ABSTRACT Individuals with Alzheimer’s disease and related dementias (ADRD) experience progressive cognitive decline and behavioral and functional impairment. With disease progression, individuals with ADRD also experience heightened risk for poor outcomes which often culminate in the need for skilled care provided in nursing homes (NH); almost all individuals with ADRD will receive short- or long-term NH care at some point. While providing high-quality, person-centered ADRD care is a national priority, progress toward this goal is limited in part by a lack of understanding regarding the influence of major comorbidities on ADRD disease burden, care needs, and symptoms. In particular, comorbid serious mental illness (SMI), which is common among individuals with ADRD, remains understudied despite its impact on disease risk, burden, care needs, and symptomatology. Burden of both ADRD and SMI is particularly high in NH settings. Understanding whether SMI plays an additive role in shaping behavioral symptom presentation among individuals with ADRD, care needs (e.g. pain), and outcomes (e.g. falls) can inform intervention targets and improve person-centered care across settings. Towards this end, I propose a mixed methods sequential explanatory design to investigate the contribution of SMI to ADRD symptoms, outcomes, and care interventions; domains informed by the Need-Driven, Dementia-Compromised Behavior Model. I will utilize secondary data available through the Minimum Data Set 3.0 (MDS 3.0) (Aim 1/1A) and conduct interviews with NH staff (Aim 2). My long-term goal is to establish a program of research designing and delivering person-centered interventions for symptom management among adults with ADRD and complex comorbidities. My short-term objective is to characterize ADRD/SMI’s relationship to shared and distinct symptomology, outcomes, and care interventions; and implications for individuals with ADRD and provision of person-centered care. Under Aim 1, I will describe patterns and characteristics of comorbid ADRD/SMI diagnosis among NH residents using 2019 MDS 3.0 NH assessment data (N~500,000). Applying clustering techniques, I will define underlying ADRD/SMI disease co-occurrences and their variation by demographic characteristics. I will then evaluate how distinct ADRD/SMI comorbidities are associated with unique behavioral symptoms, outcomes (e.g. falls, functional status) and care needs/interventions (e.g. medication use, restraint use) as compared to ADRD alone (Aim 1A). Under Aim 2, I will explain and extend Aim1/1a findings by conducting content analysis of interviews with NH staff (e.g. nurses, nursing assistants, social workers, providers) (N=30, total) about their perceptions of ADRD/SMI comorbidities and care of residents with complex cognitive and psychiatric care needs. Impact: Findings from the proposed study are responsive to ADRD research priorities and will provide foundational data informing targets for person-centered care interventions for patients with ADRD/SMI by illuminating the contributory role of SMI to ADRD symptoms and care. The training plan will support my broader career goal of becoming a leading clinician scientist focused on aging and ADRD care.

项目摘要/摘要 患有阿尔茨海默氏病和相关痴呆症（ADRD）的人经历了渐进认知能力下降 以及行为和功能障碍。随着疾病的发展，ADRD的个人也经历 不良结果的风险增加，这通常是在护士之家提供的熟练护理需求中的最终 （NH）;几乎所有患有ADRD的人都会在某个时候获得短期或长期的NH护理。提供 高质量，以人为中心的ADRD护理是国家优先事项，朝着这一目标的进步部分受到一定程度的限制 对主要合并症对ADRD疾病的影响缺乏了解伯恩，护理需求和 症状。特别是，在ADRD的个体中常见的合并症严重精神疾病（SMI）， 仍然了解其对疾病风险，负担，护理需求和症状的影响。负担 在NH设置中，ADRD和SMI都特别高。了解SMI是否在 塑造ADRD，护理需求（例如疼痛）和结果的人的行为症状表现 （例如，跌倒）可以为干预目标提供信息，并在各个情况下改善以人为本的护理。在这一目标中， 我提出了一种混合方法，顺序挖掘设计，以研究SMI对ADRD的贡献 症状，结局和护理干预措施；需求驱动的，痴呆症的知名度为域名 行为模型。我将利用通过最小数据集3.0（MDS 3.0）（AIM 1/1A）获得的辅助数据（AIM 1/1A） 并与NH员工进行采访（AIM 2）。我的长期目标是建立研究设计计划 并提供以人为中心的干预措施，以实现ADRD和复杂的成年人的症状管理 合并症。我的短期目标是表征ADRD/SMI与共享和独特的关系 症状，结局和护理干预措施；以及对ADRD和提供的个人的影响 以人为中心的护理。在AIM 1下，我将描述合并ADRD/SMI诊断的模式和特征 在使用2019 MDS 3.0 NH评估数据（N〜500,000）的NH居民中。应用聚类技术，我 将定义潜在的ADRD/SMI疾病共发生及其通过人口统计学特征的变化。我 然后将评估不同的ADRD/SMI合并症与独特的行为症状有关 结果（例如跌倒，功能状态）和护理需求/干预措施（例如用药，约束使用） 与仅ADRD相比（AIM 1A）。在AIM 2下，我将通过进行AIM1/1A的发现并扩展 与NH员工的访谈（例如护士，护士助理，社会工作者，提供者）的内容分析（n = 30， 总共）关于他们对ADRD/SMI合并症的看法以及具有复杂认知和认知居民的照顾 精神病护理需求。影响：拟议研究的发现对ADRD研究的重点有回应 并将提供基本数据，为患者的患者提供以人为中心的护理干预措施的目标 通过阐明SMI对ADRD符号和关心的贡献作用，ADRD/SMI。培训计划将 支持我成为一名专注于衰老和ADRD护理的领先临床科学家的更广泛的职业目标。