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

患有阿尔茨海默病及相关痴呆症 (ADRD) 和糖尿病的疗养院居民的破坏性行为

• 批准号: 10286786
• 负责人: KENNETH E. COVINSKY
• 金额: $ 40.38万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-15 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10286786
• 关键词: Acute; Administrative Supplement; Affect; Agitation; Algorithms; Alzheimer' s disease related dementia; American; Behavior; Behavioral Symptoms; Caregivers; Caring; Clinical; Confusion; Data; Data Analyses; Data Set; Dementia; Diabetes Mellitus; Disabled Persons; Disease; Distress; Dizziness; Elderly; Electronic Health Record; Emotional; Environmental Risk Factor; Epidemiology; Frequencies; Glucose; Goals; Hyperglycemia; Hypoglycemia; Injections; Injury; Insulin; Intervention; Intervention Studies; Laboratories; Lead; Link; Literature; Long-Term Care for Elderly; Measurement; Medical; Modeling; Nursing Homes; Older Population; Oral; Outcome; Pain; Patients; Personal Satisfaction; Persons; Pharmaceutical Preparations; Population; Prevalence; Prevention; Quality of life; Research; Resistance; Risk; Safety; Social Environment; Stress; Structure; Symptoms; Testing; Time; United States Department of Veterans Affairs; Verbal Behavior; age related; burnout; care giving burden; comorbidity; data resource; diabetes management; disability; epidemiology study; glucose monitor; improved; medication administration; prevent; therapy development

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).

项目摘要 /摘要 破坏性行为，例如抵抗护理或侵略性的身体行为，是一个关键的结果 适用于患有阿尔茨海默氏病和相关痴呆症及其护理人员的人。对于患有痴呆症的人 破坏性行为是困扰和痛苦的标志。对于看护人，破坏性行为会增加压力， 护理人员的倦怠和受伤的风险。不幸的是，我们目前对破坏行为的理解是有限的。 因为1）颠覆性行为通常是由疼痛和不适引起的，而2）患有阿尔茨海默氏症的人 疾病和相关痴呆症通常具有多种合并症，可能引起疼痛和不适，我们 提议专注于糖尿病作为模型合并症，以检查糖尿病是否是否（例如 高血糖）或糖尿病治疗（例如指法葡萄糖测量）与破坏性有关 护士之家（NH）患有痴呆症的行为。 UCSF老年美国人独立中心（OAIC）的总体目标是防止后期 在可能的情况下，残疾，以改善预防时残疾老年人的生活质量 可能（改善）。拟议的行政补品将此目标专门扩展到脆弱 居住在患有阿尔茨海默氏病和相关痴呆症的NHS中的老年人。该提议适合 指导UCSF OAIC的概念框架，该框架照顾残疾人和 痴呆症必须考虑更广泛的医疗和社会环境。我们将利用OAIC数据的专业知识 分析核心和退伍军人事务（VA）电子健康记录，包括实验室结果和 具有最小数据集（MDS）数据的药物管理数据有关破坏性行为。 我们的建议将确定糖尿病是糖尿病（包括低血糖或高血糖发作）还是糖尿病 治疗（包括指尖测量或注射胰岛素的频率）与 破坏性行为（对护理的抵抗力，侵略性的身体行为和侵略性的言语行为）。 AIM 1，我们建议确定糖尿病状态不同类型的破坏行为的普遍性 VA NH患有阿尔茨海默氏病和相关痴呆症的居民。在AIM 2A中，我们将确定 糖尿病治疗（指尖，胰岛素注射）与破坏性行为之间的关联。在AIM 2B中， 我们将确定低血糖和高血糖的发作与破坏性行为之间的关联。 拟议研究的结果将提供关键的初步数据，以支持引人注目的NIA ADRD R01 涉及痴呆症的NH种群中的颠覆性行为和合并症的申请 以及有关修改合并症是否可以减少破坏性的干预研究 行为。这项研究符合“研究的NIA战略方向，2020-2025”，以改善我们的 了解阿尔茨海默氏病和相关痴呆症（目标D），并告知发展 维持福祉并减少与年龄相关疾病的燃烧的干预措施（目标C）。