Medication Administration and Chemical Restraints in Family Caregiving for Alzheimer's Disease and Related Dementia

阿尔茨海默病和相关痴呆症家庭护理中的药物管理和化学限制

• 批准号: 10626728
• 负责人: Carolyn E Ziminski Pickering
• 金额: $ 56.66万
• 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: 2021-05-01 至 2023-08-07
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10626728
• 关键词: Address; Adverse effects; Aging; Algorithms; Alzheimer' s Disease; Alzheimer' s disease related dementia; Behavioral Symptoms; Caregivers; Caring; Characteristics; Chemicals; Classification; Clinical; Clinical assessments; Congresses; Data; Dementia; Dementia caregivers; Distress; Dose; Elder Abuse; Enrollment; Family Caregiver; Family Practice; Foundations; Frequencies; Future; Geriatric Assessment; Goals; Happiness; Health Professional; High Prevalence; Incidence; Intervention; Knowledge; Licensing; Longitudinal Studies; Measurement; Medical; Medication Management; Meta-Analysis; Morbidity - disease rate; Outcome; Patients; Pattern; Persons; Pharmaceutical Preparations; Public Health; Randomized; Recommendation; Records; Reporting; Research; Research Priority; Role; Safety; Surveys; Symptoms; Typology; United States National Institutes of Health; United States Preventative Services Task Force; Work; adverse outcome; biological adaptation to stress; care outcomes; care recipients; caregiver education; caregiver stress; caregiving; contextual factors; diaries; disorder prevention; evidence base; experience; family caregiving; high risk; innovation; medication administration; mortality; optimism; response; restraint; screening; symposium; symptom management; therapy design

Project Abstract All persons with Alzheimer’s disease and related dementias (ADRD) will experience behavioral symptoms of dementia (BSD). Management of BSD is one of the most frequent daily tasks caregivers perform, which includes deciding when to administer an “as needed” medication to address BSD. Non-pharmacologic strategies are the recommended first-line approach to manage BSD, though “as needed” medications can be warranted when non- pharmacologic strategies fail and the BSD are either causing distress to the care recipient or jeopardizing the physical safety of the care recipient or caregiver. Conversely, chemical restraint means a drug is being administered to make care more convenient for the caregiver, not because it is medically indicated. Our team has reported that 22% of ADRD family caregivers inappropriately administer medications as chemical restraints. Importantly, there are no evidence-based indications for pharmacotherapeutic management of a patient symptom for the benefit of a caregiver, aside from safety. Thus, this high prevalence is concerning, and represents an emerging public health crisis and major gap in knowledge. Given the novelty of this newly described phenomenon, the purpose of this study is to describe patterns of medication administration, chemical restraint, and associated mortality outcomes in ADRD family caregiving. To address this, we will conduct a 31- day micro-longitudinal study in which family caregivers (N=300) complete daily diaries describing BSD management including use of non-pharmacologic strategies and medications. These data will be supplemented with personal characteristics of the caregivers obtained through an enrollment survey, clinical characteristics of care recipients found in their EHR and combined with vital records data on the care recipient’s mortality. This proposed study will implement an innovative algorithm to classify medication administration as medically indicated, potentially inappropriate and chemical restraint in consideration of non-pharmacologic strategies tried, safety concerns, and distress of the care recipient (Aim 1). This study will also characterize patterns of chemical restraint to create typologies and determine characteristics of chemical restraint users (Aim 2), and determine the relationship between chemical restraint use and 1-year mortality of the care recipient (Aim 3). This study is the first step towards creating sensitive clinical assessments to identify situations at high risk of adverse outcomes related to caregiving practices. This foundational work will support a long-term research goal to evaluate if randomizing caregivers to screening for chemical restraint results in greater reduced morbidity and mortality for care recipients than the observed harms.

项目摘要 所有患有阿尔茨海默氏病和相关痴呆症（ADRD）的人都会经历 痴呆（BSD）。 BSD的管理是护理人员执行的最常见的日常任务之一，其中包括 决定何时管理“根据需要”的药物来解决BSD。非药物策略是 建议管理BSD的一线方法，尽管在非 - 药理学策略失败，BSD要么引起护理接收者的困扰，要么危害了 护理接收者或护理人员的身体安全。相反，化学约束意味着正在使用药物 管理以使护理人员更方便，不是因为它是医学上的。我们的团队 报道说，22％的ADRD家庭护理人员不适当地服用药物作为化学限制。 重要的是，没有针对患者的药物治疗管理的循证指示 除了安全性外，为照料者带来了症状。这是涉及这种高流行的，并且 代表了新兴的公共卫生危机和知识的重大差距。考虑到这个新的新奇 描述了现象，这项研究的目的是描述药物给药的模式，化学 限制和相关的死亡率结果在ADRD家庭护理中。为了解决这个问题，我们将进行31- 一日微道义研究，其中家庭护理人员（n = 300）完整描述BSD的每日日记 管理包括使用非药物策略和药物。这些数据将得到补充 具有通过入学调查获得的护理人员的个人特征， 在EHR中发现的护理接收者，并结合了有关护理人员死亡率的重要记录数据。这 拟议的研究将实施一种创新算法，以将药物给药分类为医学 考虑到未尝试的非药物策略，可能是不适当和化学限制的 安全问题和护理接收者的困扰（AIM 1）。这项研究还将表征化学模式 约束以创建类型学并确定化学约束用户的特征（AIM 2），并确定 化学约束使用与护理人员1年死亡率之间的关系（AIM 3）。这项研究是 创建敏感临床评估以确定广告高风险的情况的第一步 与护理实践有关的结果。这项基础工作将支持长期研究目标 评估随机护理人员筛查化学限制是否会导致发病率更大和 护理接收者的死亡率比观察到的危害。