Disruptive Behaviors in Nursing Home residents with Alzheimer's Disease and Related Dementias (ADRD) and Diabetes Mellitus

项目总结/摘要 破坏性行为，如拒绝照顾或攻击性的身体行为，是一个关键的结果 为阿尔茨海默氏病和相关痴呆症患者及其护理人员提供。对于痴呆症患者， 破坏性行为是痛苦和苦难的标志。对于看护者来说，破坏性行为会增加压力， 照顾者倦怠和受伤的风险。不幸的是，我们目前对破坏性行为的理解是有限的。 因为1）破坏性行为通常是由疼痛和不适引发的，2）阿尔茨海默氏症患者 疾病和相关的痴呆症往往有许多并发症，可导致疼痛和不适，我们 我建议把重点放在糖尿病作为一个模型合并症，以检查糖尿病（例如， 高血糖症）或糖尿病治疗（例如手指针刺葡萄糖测量）与破坏性 老年痴呆症疗养院（NH）居民的行为。 加州大学旧金山分校老年美国人独立中心（OAIC）的首要目标是防止晚年生活 在可能的情况下，提高残疾老年人的生活质量， 可能（改善）。拟议的行政补充规定将这一目标具体扩大到弱势群体， 居住在NH的老年人患有阿尔茨海默病和相关痴呆症。该提案符合 指导UCSF OAIC的概念框架，该框架认为，照顾残疾老人， 痴呆症必须考虑更广泛的医学和社会背景。我们将利用OAIC数据的专业知识 分析核心和退伍军人事务部（VA）的电子健康记录，包括实验室结果和 药物管理数据与关于破坏性行为的最小数据集（MDS）数据。 我们的建议将确定糖尿病（包括低血糖或高血糖发作）或糖尿病 治疗（包括手指针刺测量或胰岛素注射的频率）与 破坏性行为（抗拒照顾、攻击性身体行为和攻击性言语行为）。在 目的1，我们建议确定不同类型的破坏性行为的患病率糖尿病状态， 患有阿尔茨海默病和相关痴呆症的VA NH居民。在目标2a中，我们将确定 糖尿病治疗（手指针刺，胰岛素注射）和破坏性行为之间的关联。在目标2b中， 我们将确定低血糖和高血糖发作与破坏性行为之间的联系。 拟议研究的结果将提供关键的初步数据，以支持令人信服的NIA ADRD R 01 应用集中在破坏性行为和合并症的一般NH人群与痴呆症 以及干预研究是否修改合并症的护理可以减少破坏性 行为。这项研究符合“NIA研究战略方向，2020-2025”，以提高我们的 了解阿尔茨海默病和相关痴呆症（目标D），并为制定 采取干预措施，以维持福祉和减少与年龄有关的疾病负担（目标C）。

PROJECT SUMMARY / ABSTRACT Disruptive behaviors, such as resistance to care or aggressive physical behaviors, are a critical outcome for persons with Alzheimer’s Disease and related dementias and their caregivers. For persons with dementia, disruptive behaviors are a sign of distress and suffering. For caregivers, disruptive behaviors increase stress, caregiver burnout and risk of injury. Unfortunately, our current understanding of disruptive behaviors is limited. Since 1) disruptive behaviors are often triggered by pain and discomfort and 2) persons with Alzheimer’s Disease and related dementias often have numerous comorbidities which can cause pain and discomfort, we propose to focus on diabetes as a model comorbidity to examine whether diabetes (e.g episodes of hyperglycemia) or diabetes treatments (e.g. fingerstick glucose measurements) are associated with disruptive behaviors in nursing home (NH) residents with dementia. The overarching goal of the UCSF Older Americans Independence Center (OAIC) is to prevent late-life disability when possible, and to improve the quality of life of older people with disability when prevention is not possible (amelioration). The proposed administrative supplement extends this goal specifically to vulnerable older adults residing in NHs who have Alzheimer’s disease and related dementias. This proposal fits within the conceptual framework that guides the UCSF OAIC, which holds that care for elders with disability and dementia must consider the wider medical and social context. We will leverage the expertise of the OAIC Data Analysis Core and the Veterans Affairs (VA) electronic health records including laboratory results and medication administration data with Minimum Data Set (MDS) data on disruptive behaviors. Our proposal will determine whether diabetes (including episodes of hypo- or hyper- glycemia) or diabetes treatments (including frequency of fingerstick measurements or insulin injections) are associated with disruptive behaviors (resistance to care, aggressive physical behaviors and aggressive verbal behaviors). In Aim 1, we propose to determine the prevalence of different types of disruptive behaviors by diabetes status in VA NH residents with Alzheimer’s Disease and related dementias. In Aim 2a, we will determine the association between diabetes treatments (fingersticks, insulin injections) and disruptive behaviors. In Aim 2b, we will determine the association between episodes of hypo- and hyper- glycemia with disruptive behaviors. Results from the proposed studies would provide critical preliminary data to support compelling NIA ADRD R01 applications focusing on disruptive behaviors and comorbidities in generalizable NH populations with dementia as well as intervention studies on whether modifying the care of comorbidities can decrease disruptive behaviors. This research aligns with the “NIA Strategic Directions for Research, 2020-2025” to improve our understanding of Alzheimer’s Disease and related dementias (Goal D) and to inform the development of interventions to maintain well-being and reduce the burden of age-related diseases (Goal C).