Development of an Intervention for Long-Distance Caregivers

项目摘要 以前的照看研究主要集中在地理位置接近的阿尔茨海默氏症老年人的照顾者 疾病和相关痴呆症(AD/ADRD)，不考虑长途旅行的独特情况 照顾者(最不发达国家)。然而，来自我们之前资助的关于远程照看的R21(LDC；NIA；R21- AG050018)我们知道，很大一部分最不发达国家帮助护理接受者(CRS)具有显著的认知能力 委员会还注意到，这些最不发达国家面临着巨大的照顾者负担，他们是居住在社区的残疾人。因此， 需要制定能够满足最不发达国家具体需要的心理社会干预措施。这款R21 响应PAR-19-071的应用程序寻求利用我们在先前的R21研究中获得的知识来 使现有的循证照顾者干预(社区覆盖)适应需求和情况 对最不发达国家进行评估，并测试在实地实施这种经过调整的模式的可行性。在NIH阶段之后 行为干预发展模型，该应用程序的第一个目标是开发一种新的 为最不发达国家患有AD/ADRD的老年人提供基于技术的远程心理社会干预 社区，通过调整为最近照顾者开发的现有干预措施(阶段IA)，基于 我们之前由NIA资助的关于最不发达国家的研究(阶段0)的结果。第二个目标是进行可行性测试 在实地进行这种干预(阶段IB)。我们的长期研究目标是实现随机化的 对照试验测试基于技术的远程干预对个人最不发达国家的潜力 AD/ADRD住在家里。目前的应用集中在第一阶段(行为干预开发 和可行性测试)，并且是朝着实现我们的长期目标的下一步，即测试这种 采用随机对照试验的干预措施(第二阶段和第三阶段--疗效测试)。国际贸易组织的发展 通过使共同体适应最不发达国家的需求进行干预，将通过建立一个 护理专家咨询委员会。委员会成员将被要求帮助整合一套具体的 我们第0阶段研究的结果与最不发达国家加入社区REACH干预计划的挑战有关。 可行性研究的最不发达国家(N=40)的样本将从社区居所的家庭照顾者中抽取。 患有AD/ADRD的老年人通过获得服务的家庭护理机构接受非医疗家庭护理 种族和民族多元化的老年痴呆症患者。这将确保家庭护理助手可以支持CRS 在管理用于连接最不发达国家与CRS和助手的技术(平板电脑)方面，作为干预的一部分。我们 将确定居住在2小时车程内的最不发达国家，他们承受着沉重的照顾者负担，并邀请他们参与 在干预和可行性研究中。干预将由家庭护理人员的工作人员远程提供 联盟(FCA)。项目成果将通过解决重大的知识差距和提供 设计、实施和评估针对最不发达国家的心理社会干预措施的基础，这些干预措施可以 对最不发达国家及其关心的老年人的福祉产生长期影响。

Project Summary Prior caregiving research has mostly focused on geographically close caregivers of older adults with Alzheimer’s disease and related dementias (AD/ADRD), not considering the unique circumstances of long-distance caregivers (LDCs). However, from our previously funded R21 on long-distance caregiving (LDC; NIA; R21- AG050018) we know that a large proportion of LDCs helped care recipients (CRs) with significant cognitive impairment who were community-dwelling and that these LDCs experienced significant caregiver burden. Hence, there is a need to develop psycho-social interventions that can meet the specific needs of LDCs. This R21 application in response to PAR-19-071 seeks to draw on the knowledge gained in our previous R21 study to adapt an existing evidence-based caregiver intervention (Community REACH) to the needs and circumstances of LDCs and to test the feasibility of implementing such an adapted model in the field. Following the NIH Stage Model for Behavioral Intervention Development, the first objective of this application is to develop a novel technology-based, remotely delivered psychosocial intervention for LDCs of older adults with AD/ADRD living in the community, by adapting an existing intervention developed for proximate caregivers (Stage IA) based on findings from our previous NIA funded study on LDC (Stage 0). A second objective is to conduct feasibility testing of such an intervention in the field (Stage IB). Our long-term research goal is to implement a randomized controlled trial testing the potential of a technology-based, remotely delivered intervention for LDC of individuals with AD/ADRD living at home. The current application focuses on Stage I (behavioral intervention development and feasibility testing) and is the next step toward attainment of our long-term goal of testing the efficacy of such an intervention utilizing a randomized controlled trial (Stage II and III – efficacy testing). The development of the intervention through adaptation of Community REACH to the needs of LDCs will be achieved by creating an advisory committee of caregiving experts. Committee members will be asked to help integrate a set of specific findings from our Stage 0 study related to the challenges of LDC into the Community REACH intervention plan. The sample of LDCs (N=40) for the feasibility study will be drawn from family caregivers of community-dwelling older adults with AD/ADRD receiving non-medical home care via the access to home care agencies serving racially and ethnically diverse older adults with dementia. This will ensure that home care aides can support CRs in managing the technology (tablet) used to connect LDCs with CRs and aides as part of the intervention. We will identify LDCs living 2+ hours away who experience significant caregiver burden and invite them to participate in the intervention and feasibility study. The intervention will be delivered remotely by staff of the Family Caregiver Alliance (FCA). Project outcomes will advance the field by addressing a significant knowledge gap and providing a foundation for the design, implementation, and evaluation of LDC-specific psychosocial interventions that can have a long-term impact on the well-being of LDCs and the older adults for whom they care.