Embedding caregiver support in community-based services for older adults: A multi-site randomized trial to test the Adult Day Service Plus Program (ADS Plus)
Embedding caregiver support in community-based services for older adults: A multi-site randomized trial to test the Adult Day Service Plus Program (ADS Plus)
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DOI：
10.1016/j.cct.2019.06.010
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发表时间：
2019-08-01
影响因子：
2.2
通讯作者：
Gaugler, Joseph E.
中科院分区：
文献类型：
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作者：
Gitlin, Laura N.;Marx, Katherine;Gaugler, Joseph E.
美国有超过500万人患有痴呆症。大多数人住在家里，由家人照顾。这些家庭照顾者往往在没有疾病教育、技能培训或支持的情况下承担照顾责任，与非痴呆症照顾者相比，反过来又面临抑郁、负担和不良健康结果的风险。尽管超过200种护理干预措施已被证明具有益处，但许多护理人员无法获得这些计划。提高可及性的一种方法是将基于证据的护理人员支持方案纳入现有的面向痴呆症患者的社区服务，如成人日间服务（ADS）。在这里，我们描述了一种嵌入式实用试验的方案，该试验旨在增强被称为ADS Plus的标准ADS。ADS Plus在12个月内通过教育、推荐和解决问题的技术为家庭照顾者提供支持，并由现有的ADS工作人员现场提供。在ADS中嵌入一个程序需要了解该特定背景下的结果和实施过程。因此，我们采用了一种混合设计，包括一个集群随机两组试验，以评估治疗对护理者幸福感、ADS利用以及养老院安置的影响。我们描述了30到50个地理和种族/民族不同的参与地点的实施实践。
There are over five million people in the United States living with dementia. Most live at home and are cared for by family. These family caregivers often assume care responsibilities without education about the disease, skills training, or support, and in turn become at risk for depression, burden, and adverse health outcomes when compared to non-dementia caregivers. Despite over 200 caregiver interventions with proven benefits, many caregivers lack access to these programs. One approach to enhance access is to embed evidence-based caregiver support programs in existing community-based services for people with dementia such as adult day services (ADS). Here we describe the protocol for an embedded pragmatic trial designed to augment standard ADS known as ADS Plus. ADS Plus provides family caregivers with support via education, referrals, and problem-solving techniques over 12 months, and is delivered on-site by existing ADS staff. Embedding a program in ADS requires an understanding of outcomes and implementation processes in that specific context. Thus, we deploy a hybrid design involving a cluster randomized two-group trial to evaluate treatment effects on caregiver wellbeing, ADS utilization, as well as nursing home placement. We describe implementation practices in 30 to 50 geographically and racially/ethnically diverse participating sites.