Optimizing Dementia Care Through Collaborative Recovery Interventions

通过协作康复干预措施优化痴呆症护理

基本信息

批准号：
8984046
负责人：
Michelle M. Hilgeman
金额：
--
依托单位：
TUSCALOOSA VETERANS AFFAIRS MEDICAL CTR
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-11-01 至 2020-10-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8984046
关键词：
Address Advisory Committees Affect Age Aging Alzheimer&apos s Disease Anxiety Area Award Behavior Behavioral Symptoms Caregiver Burden Caregivers Caring Clinical Communication Communities Comorbidity Complex Consultations Counseling Data Deglutition Dementia Development Diagnosis Disease Distress Doctor of Philosophy Effectiveness Elderly Elements Emotional Emotional Stress Ensure Evidence based intervention Exercise Therapy Family Family Caregiver Feeling Foundations Funding Future Goals Grief reaction Healthcare Home environment Individual Intervention Judgment Knowledge Lead Long-Term Care Manuals Measures Memory Mental Health Mental Health Services Mentors Methods Modeling Morbidity - disease rate Nursing Homes Outcome Pain Patients Pattern Personality Persons Pilot Projects Population Psychotherapy Quality of life Randomized Randomized Controlled Trials Recommendation Recording of previous events Recovery Recruitment Activity Rehabilitation therapy Reporting Research Resources Risk Role Safety Services Social support Symptoms Telephone Training Translating Transportation Travel Update Veterans Vietnam Walking Work base behavioral health behavioral impairment burden of illness care delivery care seeking career career development caregiver depression caregiving comparison group coping dementia care depressive symptoms effective intervention efficacy testing empowered evidence base experience family support flexibility functional disability functional outcomes group intervention health administration improved improved functioning medical specialties patient oriented psychoeducation psychologic public health relevance service utilization skills systematic review telehealth treatment response

项目摘要

DESCRIPTION: Dementia affects over 7% of veterans age 65 and above seeking care through the Veteran's Health Administration (VHA), amounting to one out of every eleven veterans in some VISNs. The unique functional and behavioral impairments associated with Alzheimer's or a related dementia (ADRD) contribute substantially to psychological and physical morbidity of family caregivers and high rates of nursing home placement, with 60% of ADRD caregivers rating the emotional stress of caregiving as "high or very high," and over one third reporting depressive symptoms. Although numerous evidence-based interventions have been developed to reduce caregiver burden and improve mental health and functional outcomes of the person with dementia, a recent systematic review noted almost none of these interventions "make it off of the shelf" to be readily available in clinical settings. Care Consultation (CC) has emerged as a rare exception. CC is an evidence-based telephone intervention delivering psychoeducation, care coordination, and resource referrals in diverse areas such as safety and mental and behavioral health support. Yet CC's focus on coaching and support is inadequate for dyads experiencing high levels of distress. A stepped- intervention approach would address the VA's efficiency needs while allowing the flexibility for more resource-intensive additional counseling beyond the established CC framework when warranted by high dyad distress. This CDA-2 proposal would move such a dyadic intervention forward. Objectives: 1) Manualize the integration of care consultation and counseling components (i.e., the CC+C intervention). CC+C is guided by a rehabilitation recovery-based conceptual model to address the most common high distress targets (e.g., relationship distress, veteran or caregiver depression, anxiety, or pain) using patient-centered approaches. 2) Evaluate preliminary effectiveness and feasibility of the CC+C Intervention in a randomized controlled pilot study of distressed dyads to compare: a) the established CC intervention, to b) the CC+C intervention on veteran and caregiver outcomes. 3) Conduct exploratory analyses of the CC+C intervention on veteran long-term care placement at six and 12 months and examine two key treatment moderators (behavioral symptoms and spousal relationship status) that may impact intervention engagement and response to treatment. Methods: Ten modules combining successful elements from existing manualized therapies and exercises developed by the investigative team during the CDA-1 period will be integrated with CC into a draft CC+C intervention manual. The manual will be finalized with input from the mentoring team and an Expert Advisory Panel for completeness, feasibility, and safety and risk considerations. Next 68 distressed veterans with dementia and their family caregivers will be recruited and randomized to either the CC+C intervention group or the CC comparison group. Patient, caregiver, and relationship outcomes (e.g., burden, depressive symptoms, anxiety, quality of life, relationship distress) will be measured at baseline, 6 months, and 12 months. Treatment implementation and feasibility data will be collected. Anticipated Impacts: The goal of this career development proposal is to acquire the knowledge, skills and experience necessary to successfully compete for an RR&D Merit Review Award evaluating a randomized controlled trial powered to establish efficacy and test effectiveness of the CC+C intervention. Rehabilitation- focused interventions that maximize functioning are essential for successful non-institutional VA dementia care in the future. Work completed during the CDA-2 period will serve as a foundation for a career committed to this goal. The impact of this work will be realized when an efficacious and highly-accessible rehabilitation intervention, such as the telephone-based dyadic intervention being piloted, becomes available for aging veterans and their families.

描述：痴呆症影响了65岁及以上退伍军人通过退伍军人卫生管理局（VHA）的7％以上，在某些VISN中，每11名退伍军人中有一个。与阿尔茨海默氏症或相关痴呆症（ADRD）相关的独特功能和行为障碍，对家庭护理人员的心理和身体发病率以及护士家庭安置率高的心理和身体发病率很大，而ADRD的60％的ADRD护理人员将护理人员的情绪压力评估为“高或非常高”，并报告了三分之一的抑郁症状。尽管已经开发了许多基于证据的干预措施来减少痴呆症患者的心理健康和功能结果，但最近的一项系统评价几乎没有指出这些干预措施“使它脱离了货架”，因此在临床环境中很容易获得。护理咨询（CC）已成为罕见的例外。 CC是一种基于证据的电话干预交付心理教育，护理协调和资源推荐，例如安全，心理和行为健康支持。然而，CC专注于教练和支持的不足是遇到高水平困扰的二元组。阶梯式干预方法将满足VA的效率需求，同时允许在高达二元遇险方面保证确定的CC框架以外的更多资源密集的额外咨询中灵活性。该CDA-2提案将向前进进行这种二元干预。目标：1）手动将护理咨询和咨询组件的整合（即CC+C干预）进行整合。 CC+C以基于康复恢复的概念模型为指导，以解决使用以患者为中心的方法来解决最常见的高苦难目标（例如，关系困扰，退伍军人或照料者抑郁症，焦虑或疼痛）。 2）评估CC+C干预的初步有效性和可行性在对遇险二元组的随机控制试验研究中，以比较：a）已建立的CC干预，b）CC+C对退伍军人和照料者的介入。 3）对六个月和12个月的退伍军人长期护理放置的CC+C干预进行探索性分析，并检查两个关键治疗主持人（行为症状和配偶关系状况），这可能会影响干预的参与和对治疗的反应。方法：十个模块结合了来自现有的手动疗法和调查小组中CDA-1期间开发的练习的成功元素，将与CC集成为CC+C草案干预手册。该手册将通过心理团队的意见和专家咨询小组的完整性，可行性以及安全性和风险考虑因素进行最终确定。接下来的68名患有痴呆症及其家庭护理人员的残酷退伍军人将被招募并随机分为CC+C干预组或CC比较组。将在基线，6个月和12个月时测量患者，照顾者和关系结果（例如伯恩，抑郁症状，焦虑，生活质量，生活质量，生活质量，关系困扰）。将收集治疗实施和可行性数据。预期的影响：这项职业发展建议的目标是获得成功竞争RR＆D功绩评论奖所必需的知识，技能和经验，该奖项评估了一项随机对照试验，该试验旨在确立CC+C干预的有效性和测试有效性。以最大化功能的以康复为中心的干预措施对于未来成功的非机构VA痴呆症护理至关重要。在CDA-2期间完成的工作将成为致力于这一目标的职业的基础。当对老年退伍军人及其家人进行易于实行的简单且高度访问的康复干预措施（例如基于电话的二元干预措施，例如基于电话的二元干预）时，这项工作的影响将得到实现。