Reasoning Exercises in Assisted Living (REAL)

辅助生活中的推理练习（真实）

• 批准号: 8076804
• 负责人: KRISTINE N. WILLIAMS
• 金额: $ 18.56万
• 依托单位: UNIVERSITY OF KANSAS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-06-01 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8076804
• 关键词: Activities of Daily Living; Address; Area; Assisted Living Facilities; Attention; Behavior Therapy; Behavioral; Care given by nurses; Caring; Clinical; Clinical Trials; Cognition; Cognitive; Cognitive deficits; Communities; Competence; Cost Effectiveness Analysis; Data; Dementia; Development; Education; Educational Intervention; Educational process of instructing; Elderly; Exercise; Frail Elderly; Future; Goals; Hawthorne Effect; Health; Health Care Costs; Healthy People 2010; Home environment; Impaired cognition; Intensive Care; Intervention; Length; Length of Stay; Life; Life Experience; Link; Literature; Living Wills; Measures; Mental Depression; Modeling; National Institute of Nursing Research; Nursing Homes; Performance; Pharmaceutical Preparations; Placebos; Population; Problem Solving; Quality of life; Randomized; Randomized Clinical Trials; Recruitment Activity; Reporting; Research; Residencies; Risk; Schedule; Self Care; Self Care outcome; Supportive care; Targeted Research; Telephone; Testing; Training; Translating; Translations; aging mind; cognitive training; cost; cost effectiveness; design; dietary restriction; disability; empowered; experience; functional disability; functional status; improved; instrumental activity of daily living; mental state; mild neurocognitive impairment; post intervention; programs; protective effect; public health relevance; skills; social; therapy design

DESCRIPTION (provided by applicant): The population of older adults residing in Assisted Living (AL) facilities is expected to grow over the next decade to 2 million (Mollica & Johnson-Lemarche, 2005). Older adults who reside in AL experience progressive cognitive decline and self-care disability that necessitate the more costly and intensive care of a nursing home (NH) within an average of 1-3 years (Golant, 2004). The model of everyday competence describes how cognitive skills are linked to older adults' problem solving and self-care competency for activities of daily living (ADLs) necessary to remain in AL. Protective effects of cognitive training on problem solving and self-care performance have been empirically verified for cognitively-intact, community-dwelling elders (Willis et al., 2006). Thus, research is needed to determine whether cognitive training will improve cognition and self- care for AL residents who suffer from mild cognitive impairments. This study will test the effects of cognitive training on AL residents' everyday problem solving, self-care, and NH home placement. This study will test a new cognitive intervention, Reasoning Exercises in Assisted Living (REAL), designed specifically for AL residents. The intervention was modeled after the inductive reasoning skills found to improve cognition and maintain self-care over 5 years in healthy, independent older adults (Willis et al., 2006). REAL teaches reasoning and applied problem solving skills to empower AL residents to solve problems essential to maintain self-care that will delay NH placement (Willis, 1991, 1996). REAL successfully improved problem solving scores of AL residents in a preliminary study (Williams, 2008). Problem solving performance and self-care measures will be collected before and after the intervention with follow-ups at 3 and 6 months. Linear mixed modeling will be used to compare the REAL experimental group, a placebo VITAMIN education group, and a no treatment CONTROL group on everyday problem solving and self-care performance. Length of AL residency and NH placement will be compared between groups after 6 months. Secondary resident and facility factors that influence problem solving and self-care will be tested as covariates. Cost-effectiveness analysis will evaluate costs of providing REAL in ratio to improved self-care. This study tests a cognitive training intervention for AL residents with mild cognitive impairments, an expanding population of frail elders who are at risk for cognitive decline and self-care disability prompting NH placement. This study targets National Institute of Nursing Research (NINR) goals of promoting health through translation of behavioral interventions to clinical settings to benefit older adults and the Healthy People 2010 goals of increasing years of healthy life. The long-term goal is provide cognitive training to increase resident length of stay in AL and to identify other factors (e.g. depression) that can be modified to delay NH placement and reduce costs of care for older adults. PUBLIC HEALTH RELEVANCE: This study tests a cognitive training intervention for residents of Assisted Living facilities, a rapidly expanding population of frail elders who experience progressive cognitive and self-care decline that contributes to nursing home placement. This study targets National Institute of Nursing Research (NINR) goals of promoting health through translation of behavioral interventions to clinical settings to benefit older adults and the Healthy People 2010 goals of increasing years of healthy life. The long-term goal is to provide targeted cognitive training to promote self-care and ultimately to delay NH placement from AL, which could reduce health care costs for frail elders by over 50% per year.

描述（由申请人提供）：居住在辅助生活（AL）设施中的老年人的人口预计将在未来十年内增长到200万（Mollica＆Johnson-Lemarche，2005年）。居住在AL经验的老年人逐渐认知下降和自我保健残疾，需要在平均1 - 3年内对疗养院（NH）进行更为昂贵，更重的护理（Golant，2004年）。日常能力的模型描述了认知能力如何与老年人解决问题的问题和自我保健能力有关，以实现保留在AL中所需的日常生活（ADL）。认知训练对解决问题和自我保健表现的保护作用已在认知独立性，居住在社区的长老中得到了经验验证（Willis等，2006）。因此，需要研究以确定认知训练是否会改善患有轻度认知障碍的居民的认知和自我照顾。这项研究将测试认知培训对AL居民日常解决，自我保健和NH家庭安置的影响。 这项研究将测试专门为AL居民设计的新认知干预措施，辅助生活（真实）的推理练习。干预措施是根据发现改善认知和维持健康独立的老年人5年来维持自我保健的归纳推理技能以建模的（Willis等，2006）。 Real教授推理和应用解决问题的技能，以使AL居民能够解决维持自我保健所必需的问题，以延迟NH的安置（Willis，1991，1996）。在一项初步研究中，真正成功地改善了AL居民的问题得分（Williams，2008）。 解决问题的绩效和自我保健措施将在三个月和6个月的随访之前和之后收集。线性混合建模将用于比较真实的实验组，安慰剂维生素教育组，以及关于日常问题和自我保健表现的无治疗对照组。 6个月后，将在组之间比较Al居住和NH放置的长度。影响解决问题和自我保健的次要居民和设施因素将作为协变量进行测试。成本效益分析将评估提供实际比率和改善自我保健的成本。 这项研究对患有轻度认知障碍的AL居民进行了认知训练干预措施，这是脆弱的长老人口不断扩大的，他们处于认知能力下降和自我保健障碍的风险促使NH放置。这项研究针对国家护理研究所（NINR）的目标，即通过将行为干预转化为临床环境来促进健康，以使老年人受益，而健康的人2010年的健康目标是增强健康生活的目标。长期目标是提供认知训练，以增加居民在AL的住院时间，并确定可以修改以延迟NH放置并降低老年人护理成本的其他因素（例如抑郁症）。 公共卫生相关性：这项研究对辅助生活设施的居民进行了认知培训干预措施，这是迅速扩大的脆弱长者人口，他们经历了渐进的认知和自我保健下降，这有助于养老院的安置。这项研究针对国家护理研究所（NINR）的目标，即通过将行为干预转化为临床环境来促进健康，以使老年人受益，而健康的人2010年的健康目标是增强健康生活的目标。长期目标是提供有针对性的认知训练，以促进自我保健，并最终推迟AL的NH安置，这可能会使脆弱长者的医疗保健成本每年降低50％以上。