Proactive Primary Dementia Care

积极主动的原发性痴呆护理

• 批准号: 7897932
• 负责人: Richard H Fortinsky
• 金额: $ 16.99万
• 依托单位: UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-22 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7897932
• 关键词: Accounting; Address; Age; Aging; Alzheimer' s Disease; American; Behavioral Symptoms; Caregivers; Caring; Characteristics; Clinical; Cognitive; Communities; Comorbidity; Control Groups; Dementia; Development; Diagnosis; Educational Materials; Face; Family; Family Caregiver; Family member; Geographic Locations; Goals; Health; Healthcare; Human Resources; Individual; Insurance Carriers; Intervention; Link; Medicare; Medication Management; Memory; Memory Loss; Modeling; Monitor; Neurobehavioral Manifestations; Nurse Practitioners; Outcome; Patient Self-Report; Patients; Pharmaceutical Preparations; Pharmacotherapy; Physicians; Population; Prevalence; Primary Care Physician; Primary Health Care; Protocols documentation; Public Health; Quality of life; Randomized Controlled Trials; Recruitment Activity; Research; Resources; Risk; Self Efficacy; Services; Site; Stress; Symptoms; Syndrome; Testing; Time; Treatment Protocols; Uncertainty; United States; aged; base; community organizations; depressive symptoms; evidence base; improved; meetings; mortality; multidisciplinary; neuropsychiatry; primary care setting; programs; public health relevance; satisfaction; sound

DESCRIPTION (provided by applicant): Dementia, an age-associated clinical syndrome characterized by irreversible loss or decline in memory and other cognitive abilities, is a growing health problem. In 2008, an estimated 5.2 million Americans have Alzheimer's disease (AD), which comprises about 70 percent of all dementia; AD prevalence alone is projected to increase to more than 11 million by 2050. Family members caring for people with dementia often suffer adverse health consequences. Primary care physicians are usually the first contact for older people with memory loss complaints and their families, but substantial evidence shows that physicians face numerous constraints to providing comprehensive dementia care. Several recent randomized controlled trials to enhance primary care for these patients and families have found positive results; however, none has been successfully sustained beyond the study period or replicated in community-based primary care settings. Accordingly, the long range goal of this developmental study is to implement an evidence-based nurse-practitioner guided dementia care intervention, linked to one or more groups of primary care physicians in a defined geographic area, to maximize health-related outcomes in patients with new or recently diagnosed AD or other age-associated dementia and their family caregivers. The proposed 12-month intervention, Proactive Primary Dementia Care (PPDC), is grounded in the Progressively Lowered Stress Threshold model of dementia care, and utilizes evidence-based nonpharmacologic protocols along with medication and comorbidity monitoring in tandem with physicians. Specific aims and major hypotheses are: Specific Aim #1: Determine the preliminary efficacy of PPDC on health-related outcomes in patients and their primary family caregivers. Patient-specific hypotheses: Patients receiving PPDC will show reduced or more stabilized neuropsychiatric symptoms, and improved or more stabilized self-reported quality of life, compared to control group patients. Caregiver-specific hypotheses: Caregivers receiving PPDC will show reduced or more stabilized depressive symptoms and burden, and increased or more stabilized self-efficacy for managing dementia, compared to caregivers in the control group. Specific Aim #2: Determine the acceptability of PPDC to physicians, patients, and caregivers. Specific Aim #3: Examine the preliminary financial sustainability of PPDC. A total of 35 patient-caregiver dyads will be recruited to participate in PPDC from two primary care practice sites; 35 dyads will be recruited for the control group from two different practice sites, and they will receive and review with study personnel educational material about dementia and community resources, and will be encouraged to seek further information and help as they see fit. PUBLIC HEALTH RELEVANCE: Dementia is a public health problem of rapidly growing proportions. Cognitive and behavioral symptoms characteristic of dementia are often extremely stressful to patients and their families. The intervention proposed in this developmental study is based on substantial evidence that primary care physicians require assistance from other health care practitioners to meet the needs of patients and families from the point of diagnosis onward. Evidence-based, theoretically grounded interventions are needed to enhance dementia care in the primary care setting, in a proactive fashion from the time of diagnosis or as soon as possible thereafter, to avoid or alleviate poor health-related outcomes in patients and their family caregivers.

描述（由申请人提供）：痴呆症是一种与年龄相关的临床综合征，其特征是记忆力和其他认知能力不可逆转地丧失或下降，是一个日益严重的健康问题。 2008 年，估计有 520 万美国人患有阿尔茨海默病 (AD)，约占所有痴呆症的 70%；预计到 2050 年，仅 AD 患病率就会增加到 1100 万以上。照顾痴呆症患者的家庭成员往往会遭受不利的健康后果。初级保健医生通常是有记忆丧失症状的老年人及其家人的第一联系人，但大量证据表明，医生在提供全面的痴呆症护理方面面临诸多限制。最近几项旨在加强对这些患者和家庭的初级保健的随机对照试验已经发现了积极的结果；然而，没有一项研究能够成功地持续到研究期之后，也没有在基于社区的初级保健机构中得到复制。因此，这项发展研究的长期目标是实施基于证据的护士从业者指导的痴呆症护理干预措施，与特定地理区域的一组或多组初级保健医生联系起来，以最大限度地提高患有痴呆症的患者的健康相关结果。新发或最近诊断出的 AD 或其他与年龄相关的痴呆症及其家庭护理人员。拟议的为期 12 个月的干预措施，即主动初级痴呆护理 (PPDC)，以痴呆护理的逐步降低压力阈值模型为基础，并利用基于证据的非药物方案以及与医生配合的药物和合并症监测。具体目标和主要假设是： 具体目标#1：确定 PPDC 对患者及其主要家庭护理人员健康相关结果的初步疗效。患者特异性假设：与对照组患者相比，接受 PPDC 治疗的患者将表现出神经精神症状减轻或更加稳定，以及自我报告的生活质量改善或更加稳定。特定于照顾者的假设：与对照组的照顾者相比，接受 PPDC 的照顾者将表现出减少或更加稳定的抑郁症状和负担，以及增加或更加稳定的管理痴呆症的自我效能。具体目标#2：确定医生、患者和护理人员对 PPDC 的接受程度。具体目标#3：检查 PPDC 的初步财务可持续性。将从两个初级保健实践地点招募总共 35 名患者-护理人员双人组来参加 PPDC；将从两个不同的实践地点招募 35 名双人作为对照组，他们将收到并与研究人员一起审查有关痴呆症和社区资源的教育材料，并鼓励他们寻求他们认为合适的进一步信息和帮助。公共卫生相关性：痴呆症是一个日益严重的公共卫生问题。痴呆症特征的认知和行为症状往往给患者及其家人带来极大的压力。这项发展研究中提出的干预措施基于大量证据，表明初级保健医生从诊断开始就需要其他医疗保健从业者的帮助来满足患者和家庭的需求。需要基于证据、理论基础的干预措施，从诊断之时起或诊断后尽快采取积极主动的方式，加强初级保健机构的痴呆症护理，以避免或减轻患者及其家庭护理人员与健康相关的不良后果。

项目成果

Results and lessons learned from a nurse practitioner-guided dementia care intervention for primary care patients and their family caregivers.

从执业护士指导的初级保健患者及其家庭护理人员的痴呆症护理干预中获得的结果和经验教训。

• 发表时间: 2014-05
• 作者: Fortinsky, Richard H;Delaney, Colleen;Harel, Ofer;Pasquale, Karen;Schjavland, Elena;Lynch, John;Kleppinger, Alison;Crumb, Suzanne
• 通讯作者: Crumb, Suzanne