Promoting Reengagement in Daily Meaningful Activity Intervention for Adults with Mild Cognitive Impairment and Their Caregivers

促进轻度认知障碍成年人及其照顾者重新参与日常有意义的活动干预

• 批准号: 10378058
• 负责人: Yueh-Feng Yvonne Lu
• 金额: $ 52.53万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-05 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10378058
• 关键词: Active Listening; Activities of Daily Living; Address; Adult; Aging; Agreement; American; Anxiety; Assisted Living Facilities; Behavior Therapy; Caregiver Burden; Caregivers; Caring; Cognitive; Communication; Communities; Control Groups; Data; Dementia; Effectiveness of Interventions; Elderly; Exercise; Family; Family Caregiver; Fostering; Frustration; Future; Goals; Health; Health Promotion; Impairment; Intervention; Intervention Studies; Judgment; Knowledge; Learning; Life; Medication Management; Memory; Mental Depression; Modeling; Nurses; Outcome; Participant; Patient Care; Patient-Focused Outcomes; Patients; Perception; Performance; Persons; Pilot Projects; Problem Solving; Questionnaires; Randomized; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Reporting; Risk; Sampling; Self Efficacy; Self Management; Socialization; Support Groups; Symptoms; Testing; Time; Translations; Work; attentional control; base; cognitive training; depressive symptoms; design; efficacy evaluation; executive function; experience; improved; interest; mild cognitive impairment; multi-component intervention; nutrition; patient engagement; patient home care; prospective; satisfaction; skills; social; symptomatic improvement

PROJECT ABSTRACT This study examines efficacy of a theoretically-based, positive health focused, tailored, nurse-delivered, family- centered intervention: “Daily Engagement in Meaningful Activity” (DEMA). DEMA is designed for older persons with mild cognitive impairment (MCI) and family caregivers. Nearly 20% of Americans over 65 have MCI. Patients with MCI (patients) experience reduced life satisfaction due to patients’ increasing lack of confidence and diminished ability to perform meaningful and/or important activities, leading to diminished meaningful activity engagement, depressive symptoms, and anxiety. Caregivers lack confidence to manage their own and their patient’s daily challenges, leading to high caregiver burden, depressive symptoms, and anxiety. Patients and caregivers (dyads) report diminished satisfaction with their communication and relationship due to disagreements regarding the patient’s functional ability. Patient/caregiver behavioral interventions are more successful when they occur before progression to dementia. Previous cognitive intervention studies used limited, single domain foci (e.g., cognitive training, exercise, or nutrition) that may not be meaningful enough to sustain patient engagement long enough to improve life satisfaction. Emerging evidence, including our pilot studies, suggests regular engagement in self-identified meaningful activities can improve life satisfaction and depression and reduces risk of developing dementia. The purpose of this randomized controlled trial is to determine efficacy of DEMA compared to an information support (IS) attention control group. DEMA: 1) fosters active listening to increase dyad agreement in perceptions of patient functional ability; 2) helps dyads enhance engagement in and satisfaction with self-identified meaningful activities through problem solving to assess, prioritize, and achieve identified meaningful activity goals; 3) builds on patient’s existing interests and skills; and 4) provides information and didactic support to address priority concerns and dyad adjustment to functional changes and plan for the future. Specific aims are: 1) test DEMA’s efficacy for improve patient/ caregiver life satisfaction; 2) test DEMA’s efficacy to improve activity performance, depressive symptoms and anxiety in patients and burden, depressive symptoms, anxiety in caregivers; and, 3) explore a sub-sample of patients with higher depressive symptoms for improvement in health outcomes over time, compared to non- depressed patients. Eligible patient/caregiver dyads (n = 200) will be randomized to a 7-session DEMA or IS intervention, with data collected at baseline and 3 times over 9 months. Mixed model effects will be analyzed. If efficacious, DEMA will provide high impact on the care of patients and caregivers by maintaining their engagement in meaningful activities to improve patient and caregiver life satisfaction, depressive symptoms, anxiety, relationship satisfaction, activity performance, and caregiver burden. It will also provide information regarding the extent to which patients who have more depression may benefit and empirical evidence of the effectiveness of an intervention for translation into practice.

项目摘要 本研究探讨了一个以理论为基础的，积极的健康为重点的，量身定制的，护士提供的，家庭- 中心干预：“每日参与有意义的活动”（DEMA）。DEMA是为老年人设计的 轻度认知障碍（MCI）和家庭照顾者。65岁以上的美国人中有近20%患有MCI。 MCI患者（患者）的生活满意度下降，因为患者越来越缺乏信心 以及进行有意义和/或重要活动的能力下降，导致有意义的活动减少， 活动参与，抑郁症状和焦虑。照顾者缺乏信心来管理自己和 他们的病人的日常挑战，导致高照顾者负担，抑郁症状和焦虑。患者 和照顾者（二人组）报告说，他们的沟通和关系的满意度下降， 对患者的功能性能力有不同意见。患者/护理人员行为干预更多 在进展为痴呆症之前发生时是成功的。以前的认知干预研究使用 有限的单域焦点（例如，认知训练，锻炼或营养），可能没有足够的意义， 维持患者参与足够长的时间，以提高生活满意度。新出现的证据，包括我们的飞行员 研究表明，定期参加自我认定的有意义的活动可以提高生活满意度， 抑郁症，降低患痴呆症的风险。这项随机对照试验的目的是 确定DEMA与信息支持（IS）注意力控制组相比的功效。DEMA：1）培养 积极倾听，增加对患者功能能力的感知的二分一致性; 2）帮助二分提高 通过解决问题来评估自我确定的有意义的活动的参与和满意度， 优先考虑，并实现确定的有意义的活动目标; 3）建立在病人现有的兴趣和技能; 和4）提供信息和教学支持，以解决优先关注和二元调整， 功能变化和未来计划。具体目的是：1）测试DEMA对改善患者/ 照顾者生活满意度; 2）测试DEMA的功效，以改善活动表现，抑郁症状， 患者的焦虑和负担，抑郁症状，焦虑的照顾者;和，3）探索一个子样本 随着时间的推移，与非抑郁症状患者相比， 抑郁症患者合格的患者/护理人员配对（n = 200）将被随机分配至7次DEMA或IS 干预，在基线和9个月内3次收集数据。将分析混合模型效应。 如果有效，DEMA将通过维持患者和护理人员的健康， 参与有意义的活动，以改善患者和护理人员的生活满意度，抑郁症状， 焦虑、关系满意度、活动表现和照顾者负担。它还将提供信息 关于有更多抑郁症的患者可能受益的程度和 将干预措施转化为实践的有效性。