Adapting CAPABLE as CAPABLE-Family for the Caregiver Care-Recipient Dyad with Alzheimer's Disease and Related Dementias (ADRD) and Disability

使患有阿尔茨海默氏病及相关痴呆症 (ADRD) 和残疾的看护者与被看护者二元组的能力成为能力家庭

• 批准号: 10195902
• 负责人: Emerald Jenkins
• 金额: $ 4.78万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10195902
• 关键词: Activities of Daily Living; Address; Adult; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Attention; Behavior Therapy; Behavioral; Caregiver Burden; Caregiver well-being; Caregivers; Caring; Chronic; Clinical Trials; Cognitive; Collaborations; Communication; Communities; Degenerative Disorder; Dementia; Dependence; Development; Disease; Distress; Elderly; Empathy; Environment; Evidence based program; Family; Family Caregiver; Feedback; Foundations; Funding; Future; Goals; Grant; Health; Health care facility; Healthcare; Home; Home environment; Hospice Care; Human; Impaired cognition; Income; Individual; Intervention; Interview; Link; Long-Term Care; Measures; Mental Depression; Mental Health; Mentors; Methods; Minority; Mission; Modeling; Morbidity - disease rate; National Institute on Aging; Nursing Homes; Occupational Therapist; Outcome; Pain; Participant; Personal Satisfaction; Persons; Phase; Physical Function; Physiological; Polypharmacy; Process; Program Development; Provider; Psychological Impact; Public Health; Qualitative Methods; Qualitative Research; Randomized; Registered nurse; Research; Risk Factors; Scientist; Site; Social Impacts; Social isolation; Societies; Source; Supervision; Techniques; Testing; Time; Training; Training and Education; United States; Visual; age related; aging in place; base; care recipients; career development; caregiving; cognitive ability; control trial; design; disability; disabling disease; economic impact; effective intervention; experience; functional independence; high risk; human old age (65+); ideation; improved; improved functioning; informal caregiver; innovation; instrumental activity of daily living; meetings; member; mental state; mortality; mortality risk; open label; physical conditioning; physically handicapped; programs; protocol development; prototype; psychological distress; skills; social

Project Summary Co-occurring physical and cognitive impairments are an important public health concern in older adults with Alzheimer's Disease and Related Dementias (ADRD) leading to: decreased functional independence and increased mortality. Caregiving for persons with co-occurring ADRD and physical disability is a direct risk factor for nursing home placement for care recipients, and a source of chronic physiologic stress for caregivers resulting in poor health, lost income, physical burden, psychological distress, social isolation and for those most distressed, increased risk of mortality. Thus, it is important to maintain and improve the cognitive and functional ability of older adults with ADRD and their caregivers. The majority of studies for physical interventions in older adults with cognitive impairment focus on: (1) ADRD in later stages, (2) nursing home and long-term care facility residents instead of home-based settings, and (3) few outcomes directly measured physical function (ADLs, IADLs) with geriatric standards of care. The scientific gap is a physical intervention in older adults with cognitive impairment which focuses on: (1) ADRD in earlier stages, (2) home-based settings, and (3) outcomes directly measuring function with Katz ADLs and Lawton's IADLs. The CAPABLE program is currently implemented in more than 30 sites across 16 states and uses the expertise of a Registered Nurse (RN), Occupational Therapist (OT), and Handyworker (HW) to address the home environment and strengths of older adults with disability to improve function, however excludes persons with ADRD. The purpose of this study is to address the needs of older adults with co-occurring ADRD and physical disability and their caregivers with a human centered design (HCD) program, CAPABLE-Family, using the Verbrugge and Jett Disablement Process Model as the theoretical framework. The long term-goal is to offer CAPABLE-Family at CAPABLE sites across the nation, providing benefits to a broader range of older adults. The specific aims are: SA1: To adapt the CAPABLE program to focus on meeting the needs of older adults with co-occurring ADRD and physical disabilities and their caregivers (CAPABLE-Family), and SA2: To evaluate the acceptability, feasibility, and preliminary effect size of CAPABLE-Family in older. In SA1, the dissertation study, the applicant seeks to identify caregiver and care recipient needs, such as: disability, environmental challenges, pain, depression, polypharmacy, provider communication needs, and caregiver burden. This study aligns with the NIA's mission to include research on chronic disabling, and degenerative diseases of aging, with a particular focus on AD; on multiple morbidities, on individual behavioral changes with aging, and on caregiving. The 1-year protocol development includes: contextual qualitative research, synthesis/ideation, and prototype testing from HCD with n=10 dyads, 10 RNs, and 10 OTs. Phases 4/5 provide clinical trials research experience directed by the Primary Mentor. This research contributes to the development of a goal-directed human-centered behavioral intervention for older adults.

项目摘要 同时发生的身体和认知障碍是老年人的一个重要的公共卫生问题， 阿尔茨海默病和相关痴呆症（ADRD）导致：功能独立性降低， 增加死亡率。对同时患有ADRD和身体残疾的人的护理是一个直接的风险因素 对于护理接受者的护理之家安置，以及护理者的慢性生理压力的来源， 健康状况不佳、失去收入、身体负担、心理痛苦、社会孤立， 痛苦，死亡风险增加。因此，维持和改善认知和功能是非常重要的 老年ADRD患者及其照顾者的能力。大多数关于老年人身体干预的研究 有认知障碍的成年人关注：（1）ADRD后期，（2）疗养院和长期护理机构 居民，而不是家庭为基础的设置，和（3）很少的结果直接测量身体功能（ADL， IADL）与老年护理标准。科学的差距是一个物理干预老年人的认知 损伤，重点是：（1）早期ADRD，（2）家庭环境，（3）直接结果 用Katz ADL和Lawton的IADL测量功能。该计划目前正在实施， 在16个州的30多个地点，并使用注册护士（RN），职业治疗师 (OT)，以及Handyworker（HW），以解决残疾老年人的家庭环境和优势， 功能改善，但不包括ADRD患者。这项研究的目的是解决需要 同时发生ADRD和身体残疾的老年人及其照顾者， 设计（HCD）程序，CAPABLE系列，使用Verbrugge和Jett禁用过程模型作为 理论框架。长期目标是在全国各地的有能力的地点提供有能力的家庭， 为更广泛的老年人提供福利。具体目标是：战略目标1： 该计划的重点是满足老年人的需要，同时发生ADRD和身体残疾， 照顾者（CAPABLE-家庭）和SA 2：评价以下方法的可接受性、可行性和初步效应量： 能-家庭在老年人。在论文研究SA 1中，申请人试图确定照顾者和照顾 接受者的需求，如：残疾，环境挑战，疼痛，抑郁症，多种药物，提供者 沟通需求和照顾者负担。这项研究符合NIA的使命，包括研究 慢性致残和退行性疾病的老龄化，特别是重点对AD;对多种疾病， 个体行为随着年龄的增长而变化，并在衰老过程中发生变化。1年方案制定包括： 背景定性研究，综合/构思，和原型测试从HCD与n=10二分，10 RN， 10个OT第4/5阶段提供由主要导师指导的临床试验研究经验。本研究 有助于为老年人制定目标导向的以人为本的行为干预。