Reasoning Exercises in Assisted Living (REAL)

辅助生活中的推理练习（真实）

基本信息

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
项目类别：
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

项目摘要

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) 设施中的老年人口预计在未来十年将增长到 200 万（Mollica & Johnson-Lemarche，2005 年）。居住在 AL 的老年人会经历进行性认知衰退和自理能力障碍，平均需要 1-3 年内前往疗养院 (NH) 接受更昂贵的重症监护（Golant，2004）。日常能力模型描述了认知技能如何与老年人解决问题的能力以及留在 AL 所需的日常生活活动 (ADL) 的自我护理能力联系起来。认知训练对解决问题和自我保健表现的保护作用已被认知完好的社区老年人的经验证实（Willis 等，2006）。因此，需要进行研究来确定认知训练是否能够改善患有轻度认知障碍的 AL 居民的认知和自我护理。本研究将测试认知训练对 AL 居民日常问题解决、自我护理和 NH 居家安置的影响。这项研究将测试一种新的认知干预措施，即辅助生活推理练习 (REAL)，专为 AL 居民设计。该干预措施以归纳推理技能为蓝本，发现归纳推理技能可以在健康、独立的老年人中改善认知并维持 5 年以上的自我护理（Willis 等，2006）。 REAL 教授推理和应用问题解决技能，使 AL 居民能够解决维持自我护理所必需的问题，从而延迟 NH 安置（Willis，1991，1996）。在一项初步研究中，REAL 成功提高了 AL 居民解决问题的得分（Williams，2008）。将在干预前后收集解决问题的表现和自我保健措施，并在 3 个月和 6 个月进行随访。将使用线性混合模型来比较真实实验组、安慰剂维生素教育组和不治疗对照组在日常问题解决和自我护理表现方面的情况。 6 个月后，将比较各组之间的 AL 住院医师实习时间和 NH 安置时间。影响问题解决和自我护理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 REAL 的成本与改善自我护理的比率。这项研究测试了针对患有轻度认知障碍的 AL 居民的认知训练干预措施，以及越来越多的体弱老年人群体，他们面临认知能力下降和自理障碍的风险，促使 NH 安置。这项研究的目标是国家护理研究所 (NINR) 的目标，即通过将行为干预措施转化为临床环境来促进健康，使老年人受益，以及健康人 2010 目标，即延长健康寿命。长期目标是提供认知培训，以增加住院医师在 AL 的住院时间，并确定可以修改的其他因素（例如抑郁症），以延迟 NH 安置并降低老年人的护理费用。公共健康相关性：这项研究测试了对辅助生活设施居民的认知训练干预措施，这是一个快速增长的体弱老年人群体，他们的认知和自理能力逐渐下降，从而导致了疗养院的安置。这项研究的目标是国家护理研究所 (NINR) 的目标，即通过将行为干预措施转化为临床环境来促进健康，使老年人受益，以及健康人 2010 目标，即延长健康寿命。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，这可以每年将体弱老年人的医疗费用减少 50% 以上。