Testing Dementia Caregiver TeleCoaching to Reduce Episodes of Abuse and Neglect by Recognizing and Managing Care-Resistant Behaviors

项目摘要 在家庭照顾的情况下，患有阿尔茨海默病和相关痴呆症(ADRD)的人更有可能 与独居或不需要护理援助的老年人相比，他们更容易受到虐待和忽视。 虐待和忽视老年人(EAN)的定义是由信任关系中的人犯下的行为，导致 对老年人的健康和福祉造成伤害的实际风险或增加风险。EAN由不同的子类型组成，如 身体和心理上的虐待和忽视。约一半痴呆症患者的家庭照顾者自我照顾 报告至少执行这三种EAN子类型中的一种。这项建议评估了一种基于证据的远程指导 干预、抵抗照顾行为互联网培训(HRT-IT)，以提高家庭照顾者的应对技能 并减少虐待和忽视老年人(EAN)。CRB包括患有ADRD的人为抵制或 拒绝给予照顾的帮助，例如拒绝张开嘴巴进行口腔护理或使用身体攻击。我们的 远程辅导干预(CREST-IT)，通过教授实践来提高解决问题的应对技能 管理CRB的策略，有效地减少CRB相关照顾者的痛苦。我们将测试这些措施的有效性 在多时间序列方法内的延迟干预随机临床试验中的抑制-IT。护理员在 立即干预组和延迟干预组(N=266)将完成4次仪器完成和每日 描述CRB和EAN在基线、3个月、6个月、 再过9个月。延迟干预的照顾者将每周收到短信，以减少夸大的干预效果 在3个月的随访期后，延迟干预组将 接受遏制IT干预。这种设计使我们能够最大限度地检查疗效(组内)， 行动机制和干预延迟(集团内)。为此，我们提出了以下具体目标：1) 测试在线护理抵抗行为指导干预在降低EAN频率方面的有效性(A) 实验组(即刻干预组)与对照组(延迟干预组)比较 (组间)和(B)从干预前到干预后的人内；2)检验假设的机制 通过多层次结构方程建模评估CRB-应激之间的关系 评估、使用以遏制IT问题为中心的应对策略和EAN；以及3)在 干预后3个月和6个月，以确定干预的性能并通知助推器的时间表 会话。我们还将评估遏制IT干预措施在预防家庭使用EAN方面的效果 作为探索性目标的照顾者。这项建议直接解决了由 美国国立卫生研究院疾病预防办公室和美国预防工作组。该研究计划的下一步将是 专注于向实践环境的转换，如UAB卫生系统的照顾者丧亲服务线路 和成人保护服务。

PROJECT ABSTRACT In family caregiving situations, those with Alzheimer’s disease and related dementia (ADRD) are more likely to experience elder abuse and neglect (EAN) than older adults living alone or not requiring assistance with care. Elder abuse and neglect (EAN) is defined as acts committed by a person in a trusted relationship that cause actual or increased risk of harm to an older adults’ health and wellbeing. EAN consists of different subtypes such as physical and psychological abuse and neglect. About half of family caregivers for persons with dementia self- report doing at least one of these three EAN subtypes. This proposal evaluates an evidence-based tele-coaching intervention, Care-Resistant Behavior Internet Training (CuRB-IT) to enhance coping skills of family caregivers and reduce elder abuse and neglect (EAN). CRB includes actions taken by a person with ADRD to resist or refuse assistance with care, such as refusing to open their mouth for oral care or using physical aggression. Our tele-coaching intervention (CuRB-IT), which increases problem-solving coping skills by teaching practical strategies to manage CRBs, effectively reduces CRB-related caregiver distress. We will test the effectiveness of CuRB-IT in a delayed-intervention randomized clinical trial, within a multi-time series approach. Caregivers in immediate- and delayed-intervention groups (N=266) will complete 4 waves of instrument completion and daily diary surveys describing the frequency of CRB and EAN over a 21-day period at baseline, 3 months, 6 months, and 9 months. Delayed-intervention caregivers will receive weekly texts to reduce inflated intervention effects inherent in many wait-list control designs.22 After the 3-month follow-up, the delayed-intervention group will then receive the CuRB-IT intervention. This design allows us to maximize power to examine efficacy (between-group), mechanism-of-action, and intervention delay (within-group). Thus, we propose the following Specific Aims: 1) Test the efficacy of an online care-resistant behavior coaching intervention in reducing frequency of EAN (a) among the experimental (immediate-intervention group) as compared to the control (delayed-intervention group) (between groups) and (b) within-person from pre- to post- intervention.; 2) Test hypothesized mechanism of action through multi-level structural equation modeling to assess the relationships between CRB-stress appraisal, use of CuRB-IT problem-focused coping strategies and EAN; and 3) Examine intervention decay at 3- and 6-months post intervention to determine performance of intervention and inform scheduling of booster sessions. We will also assess the efficacy of the CuRB-IT intervention in preventing onset of EAN use by family caregivers as an exploratory aim. This proposal directly addresses high-priority research gaps identified by the NIH Office of Disease Prevention and US Preventative Task Force. Next steps in this research program will focus on translation to practice settings such as the UAB Health system’s Caregiver Bereavement Service Line and Adult Protective Services.