Decision Making Among Older Adults: the AUTO study

老年人的决策：AUTO 研究

• 批准号: 10266192
• 负责人: Marian Elizabeth Betz
• 金额: $ 66.1万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10266192
• 关键词: Age; Age-associated memory impairment; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Assessment tool; Automobile Driving; Behavioral Model; Clinical; Clinical Medicine; Cognitive; Communities; Complement; Conflict (Psychology); Data; Decision Aid; Decision Making; Dementia; Distant; Elderly; Emotional; Emotions; Enrollment; Face; Family; Family member; Foundations; Friends; Future; Goals; Health; Health Personnel; Home; Impaired cognition; Impairment; Individual; International; Intervention; Interview; Knowledge; Lead; Life; Link; Location; Measures; Mental Depression; Modeling; Modification; Motivation; Nature; Online Systems; Outcome; Participant; Patients; Personal Satisfaction; Persons; Policies; Population; Positioning Attribute; Prevalence; Primary Health Care; Provider; Questionnaires; Randomized Controlled Trials; Readiness; Regrets; Research; Research Project Grants; Resources; Retirement; Risk; Role; Safety; Self Assessment; Services; Site; Suggestion; Surveys; Testing; Time; Translational Research; Trust; United States National Institutes of Health; Work; Wrestling; care providers; cognitive function; decision-making capacity; depressive symptoms; driving behavior; driving safety; efficacy testing; emotional factor; future implementation; health care settings; improved; improved outcome; innovation; intervention delivery; loved ones; mild cognitive impairment; multidisciplinary; older driver; patient oriented; programs; psychosocial; psychosocial wellbeing; randomized trial; screening; therapy development; tool; web-accessible

7. PROJECT SUMMARY Decisions about driving cessation are emotionally difficult for older adults, their family members, and their providers – and they are also ubiquitous and of critical importance. Cognitive impairment – including from Alzheimer’s disease in its earliest stages – complicates driving decisions and has been linked to both driving risk and the need for eventual driving cessation. Issues with driving may be an early-warning sign of cognitive impairment associated with Alzheimer’s disease and related dementia, when persons may still have decision-making capacity. Prior work shows that older adults want to make decisions about driving themselves, and they want time to prepare for transitions especially because driving cessation can lead to decreased independence and mobility and, consequently, poor psychosocial outcomes such as depression and isolation. An existing web-based driving decision aid (DDA) offers the potential to educate older adults, help them clarify their values and understand their options, and make the decision that is right for them. This R01 proposal builds on preliminary work aligned with the NIH Stage Model for Behavioral Intervention Development (Stage II efficacy testing of a previously developed intervention) and is responsive to the FOA’s call for translational work to leverage cognitive, emotional and motivational strengths to facilitate optimal decision-making. Over a five-year period, our multi-disciplinary, established study team aims to (1) test the efficacy of the DDA in improving decision quality, (2) determine the DDA’s effects in specific subpopulations of older adults, including individuals with early Alzheimer’s disease and/or mild cognitive impairment, and (3) identify the best settings for future DDA use. Our underlying hypotheses are that the DDA will help older adults, including those with Alzheimer’s disease-related cognitive impairment, make high-quality decisions (i.e., informed and in line with their values), which will mitigate the negative psychosocial impacts of driving cessation, and that optimal DDA effects will be found in certain populations in certain settings. We will first test the DDA’s efficacy in a three-site, two-armed randomized controlled trial of older drivers (n=300, ≥70 years), as compared to a web-based control (basic information about driving without guided decision-making). Older driver enrollment will be complemented by enrollment of one “family member” (relative or trusted friend) per driver. The primary trial outcome (immediate) will be self-rating of decision quality (Aim 1a). We will also test the DDA’s longitudinal effects on psychosocial outcomes (Aim 1b) and driving behaviors (Aim 1c) at 12 and 24 months. We will next use the trial data for stratified analyses of the DDA’s effect on decision quality in subpopulations defined by cognitive function – including individuals with early-stage Alzheimer’s disease (Aim 2a), decisional capacity (Aim 2b), and attitudinal readiness to stop driving (Aim 2c). In Aim 3, we will use questionnaires and qualitative interviews to examine DDA acceptability and preferred timing and setting for use. Key stakeholders will include older drivers, family members (or trusted friends), healthcare providers caring for older adults – including those who provide services for persons with Alzheimer’s disease and related dementia, and leaders in older driver research and policy. The roles of family members and healthcare providers in supporting drivers gain additional importance in the context of concerns about cognitive or decisional capacity, including in Alzheimer’s disease and mild cognitive impairment, highlighting the need for inclusion of their perspectives in research. The proposed research fills a critical need for usable tools to help older adults safely retire from driving while maintaining independence, mobility and well-being. The planned analyses will allow tailoring and dissemination to older drivers with dementia and their families; this may include dissemination through healthcare settings with targeted guidance to clinicians about when in the course of Alzheimer’s disease to use the decision aid or public-facing resources. The aging of the population lends urgency to these issues, and our proposed work will provide the scientific foundation for future implementation of an effective, patient-centered driving decision aid in real-world settings. Understanding how, with whom, and when to use a driving decision aid offers the potential to significantly improve the independence, health, and well-being of millions of older adults.

7.项目总结 对于老年人、他们的家庭成员和他们的提供者来说，关于停止驾驶的决定在情感上是困难的--而且他们也无处不在，而且至关重要。认知障碍--包括早期的阿尔茨海默氏症--使驾驶决策变得复杂，并与驾驶风险和最终停止驾驶的需要有关。驾驶问题可能是阿尔茨海默病和相关痴呆症相关认知障碍的早期预警信号，届时人们可能仍有决策能力。先前的研究表明，老年人希望自己做出开车的决定，他们希望有时间为过渡做准备，特别是因为停止开车可能会导致独立性和机动性降低，从而导致抑郁和孤立等不良心理社会后果。现有的基于网络的驾驶决策辅助(DDA)提供了教育老年人的潜力，帮助他们澄清自己的价值观，了解自己的选择，并做出适合他们的决定。这份R01提案建立在与NIH行为干预发展阶段模型(先前开发的干预措施的第二阶段疗效测试)相一致的前期工作的基础上，并响应了FOA关于翻译工作的呼吁，以利用认知、情感和动机的优势来促进最佳决策。在五年的时间里，我们的多学科、成熟的研究团队旨在(1)测试DDA在提高决策质量方面的有效性，(2)确定DDA在特定老年人亚群中的效果，包括早期阿尔茨海默病和/或轻度认知障碍的个人，以及(3)确定未来DDA使用的最佳环境。我们的基本假设是，DDA将帮助老年人，包括那些与阿尔茨海默病相关的认知障碍的人，做出高质量的决定(即，知情并符合他们的价值观)，这将减轻戒车带来的负面心理社会影响，并且在特定的环境下，将在特定的人群中找到最佳的DDA效果。我们将首先在三个地点的双臂随机对照试验中测试DDA的有效性，老年司机(n=300，≥70岁)与基于网络的对照(关于在没有指导决策的情况下驾驶的基本信息)进行比较。较老的司机注册将通过为每个司机注册一个“家庭成员”(亲戚或信任的朋友)来补充。主要试验结果(立即)将是对决策质量的自我评级(目标1a)。我们还将在12个月和24个月时测试DDA对心理社会结果(目标1b)和驾驶行为(目标1c)的纵向影响。接下来，我们将使用试验数据对认知功能定义的亚群中DDA对决策质量的影响进行分层分析-包括早期阿尔茨海默病患者(目标2a)、决策能力(目标2b)和停止驾驶的态度准备(目标2c)。在目标3中，我们将使用问卷和定性访谈来审查DDA的可接受性以及首选的使用时机和环境。主要利益相关者将包括老年司机、家人(或值得信赖的朋友)、照顾老年人的医疗保健提供者-包括那些为阿尔茨海默病和相关痴呆症患者提供服务的人，以及老年司机研究和政策方面的领导者。在对包括阿尔茨海默病和轻度认知障碍在内的认知或决策能力的担忧背景下，家庭成员和医疗保健提供者在支持司机方面的作用变得更加重要，这突显了将他们的观点纳入研究的必要性。这项拟议的研究填补了对可用工具的迫切需求，可以帮助老年人安全地从驾驶中退休，同时保持独立性、机动性和幸福感。计划中的分析将允许对患有痴呆症的老年司机及其家人进行量身定做和传播；这可能包括通过医疗保健环境传播，有针对性地指导临床医生在阿尔茨海默病过程中何时使用决策辅助工具或面向公众的资源。人口老龄化使这些问题变得更加紧迫，我们提出的工作将为未来在现实世界中实施有效的、以患者为中心的驾驶决策辅助提供科学基础。了解如何、与谁以及何时使用驾驶决策辅助工具，有可能显著提高数百万老年人的独立性、健康和幸福感。