Effectiveness of Expanded Implementation of STAR-VA for Managing Dementia-Related Behaviors Among Veterans
Effectiveness of Expanded Implementation of STAR-VA for Managing Dementia-Related Behaviors Among Veterans
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DOI：
10.1093/geront/gnv068
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发表时间：
2016-02-01
期刊：
影响因子：
5.7
通讯作者：
Karlin, Bradley E.
中科院分区：
文献类型：
--
作者：
Karel, Michele J.;Teri, Linda;Karlin, Bradley E.
研究目的：非药物，心理社会方法是管理痴呆症行为症状的一线治疗方法，但在长期护理环境中实施可能具有挑战性。退伍军人健康管理局实施了STAR-VA，这是一种跨学科的行为方法，用于管理社区生活中心（CLC，养老院护理）环境中具有挑战性的痴呆相关行为。本研究描述了该计划是如何实施的，并提供了一个评估退伍军人的临床结果和工作人员的反馈意见的干预。设计和方法：来自17个社区联络中心的一名心理健康专业人员和注册护士团队完成了STAR-VA培训，这需要一个体验式研讨会，然后是6个月的专家咨询，因为他们与他们的团队合作，实施STAR-VA与退伍军人确定有挑战性的痴呆症-相关行为。在基线和干预完成时评估目标行为和抑郁、焦虑和激越症状的频率和严重程度。工作人员提供反馈STAR-VA的可行性和影响。结果：七十一退伍军人完成了干预。行为分为6种类型：护理拒绝或抵抗，激动，攻击，喊叫，徘徊和其他。目标行为的频率和严重程度以及抑郁、焦虑和激动的症状都显著降低，总体效应量为1或更大。工作人员评价退伍军人和计划的可行性favorably.Implications：这项评估支持的可行性和有效性的STAR-VA，跨学科的，行为干预管理具有挑战性的行为，居民痴呆症在CLC。
Purpose of the Study: Nonpharmacological, psychosocial approaches are first-line treatments for managing behavioral symptoms in dementia, but they can be challenging to implement in long-term care settings. The Veterans Health Administration implemented STAR-VA, an interdisciplinary behavioral approach for managing challenging dementia-related behaviors in its Community Living Center (CLCs, nursing home care) settings. This study describes how the program was implemented and provides an evaluation of Veteran clinical outcomes and staff feedback on the intervention.Design and Methods: One mental health professional and registered nurse team from 17 CLCs completed STAR-VA training, which entailed an experiential workshop followed by 6 months of expert consultation as they worked with their teams to implement STAR-VA with Veterans identified to have challenging dementia-related behaviors. The frequency and severity of target behaviors and symptoms of depression, anxiety, and agitation were evaluated at baseline and at intervention completion. Staff provided feedback regarding STAR-VA feasibility and impact.Results: Seventy-one Veterans completed the intervention. Behaviors clustered into 6 types: care refusal or resistance, agitation, aggression, vocalization, wandering, and other. Frequency and severity of target behaviors and symptoms of depression, anxiety, and agitation all significantly decreased, with overall effect sizes of 1 or greater. Staff rated both benefits for Veterans and program feasibility favorably.Implications: This evaluation supports the feasibility and effectiveness of STAR-VA, an interdisciplinary, behavioral intervention for managing challenging behaviors among residents with dementia in CLCs.