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.

项目概要/摘要 阿尔茨海默病和相关痴呆症 (ADRD) 患者的认知能力会逐渐下降 随着疾病的进展，ADRD 患者也会出现行为和功能障碍。 造成不良结果的众多风险，往往最终需要疗养院提供熟练的护理 (NH)；几乎所有患有 ADRD 的人都会在某个时候接受短期或长期的 NH 护理。 高质量、以人为本的 ADRD 护理是国家优先事项，但实现这一目标的进展部分受到 对主要合并症对 ADRD 疾病负担、护理需求和治疗的影响缺乏了解 特别是，合并严重精神疾病（SMI），这在 ADRD 患者中很常见， 尽管它对疾病风险、负担、护理需求和症状负担有影响，但仍然没有得到充分研究。 ADRD 和 SMI 在 NH 环境中都特别高，了解 SMI 是否在其中发挥附加作用。 塑造 ADRD 患者的行为症状表现、护理需求（例如疼痛）和结果 （例如跌倒）可以为干预目标提供信息并改善跨环境的以人为本的护理。 我提出了一种混合方法序贯解释性设计来研究 SMI 对 ADRD 的贡献 症状、结果和护理干预措施；由需求驱动、痴呆症受损者提供的信息 行为模型。我将利用通过最小数据集 3.0 (MDS 3.0) 提供的辅助数据（目标 1/1A） 并对 NH 工作人员进行访谈（目标 2）。 并为患有 ADRD 和复杂症状的成人提供以人为本的干预措施 我的短期目标是描述 ADRD/SMI 与共享和独特的关系。 症状、结果和护理干预措施；以及对 ADRD 患者的影响和提供 在目标 1 下，我将描述共病 ADRD/SMI 诊断的模式和特征。 使用 2019 年 MDS 3.0 NH 评估数据（N~500,000）对 NH 居民进行聚类分析，I。 将定义潜在的 ADRD/SMI 疾病共存及其随人口特征的变化。 然后将评估不同的 ADRD/SMI 合并症与独特的行为症状之间的关系， 结果（例如跌倒、功能状态）和护理需求/干预措施（例如药物使用、约束使用） 与单独的 ADRD 相比（目标 1A），在目标 2 下，我将通过进行解释和扩展 Aim1/1a 的发现。 对 NH 工作人员（例如护士、护理助理、社会工作者、服务提供者）进行访谈的内容分析（N=30， 总计）关于他们对 ADRD/SMI 合并症的看法以及对具有复杂认知和认知障碍的居民的护理 影响：拟议研究的结果响应了 ADRD 研究重点。 并将提供基础数据，为患有以下疾病的患者提供以人为本的护理干预措施的目标 ADRD/SMI 通过阐明 SMI 对 ADRD 症状和护理的贡献作用。 支持我更广泛的职业目标，即成为专注于老龄化和 ADRD 护理的领先临床科学家。