Adapting CAPABLE as CAPABLE-Family for the Caregiver Care-Recipient Dyad with Alzheimer's Disease and Related Dementias (ADRD) and Disability

使患有阿尔茨海默氏病及相关痴呆症 (ADRD) 和残疾的看护者与被看护者二元组的能力成为能力家庭

• 批准号: 10396081
• 负责人: Emerald Jenkins
• 金额: $ 1.75万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10396081
• 关键词: Activities of Daily Living; Address; Adult; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Attention; Behavior Therapy; Behavioral; Caregiver Burden; Caregiver well-being; Caregivers; Caring; Chronic; Clinical Trials; Cognitive; Collaborations; Communication; Communities; Degenerative Disorder; Dementia; Dependence; Development; Disease; Distress; Elderly; Empathy; Environment; Evidence based program; Family; Family Caregiver; Feedback; Foundations; Funding; Future; Goals; Grant; Health; Health care facility; Healthcare; Home; Home environment; Hospice Care; Human; Impaired cognition; Income; Individual; Intervention; Interview; Link; Long-Term Care; Measures; Mental Depression; Mental Health; Mentors; Methods; Minority; Mission; Modeling; Morbidity - disease rate; National Institute on Aging; Nursing Homes; Occupational Therapist; Outcome; Pain; Participant; Personal Satisfaction; Persons; Phase; Physical Function; Physiological; Polypharmacy; Process; Program Development; Provider; Psychological Impact; Public Health; Qualitative Methods; Qualitative Research; Randomized Controlled Trials; Registered nurse; Research; Risk Factors; Scientist; Site; Social Impacts; Social isolation; Societies; Source; Supervision; Techniques; Testing; Time; Training; Training and Education; United States; Visual; age related; aging in place; base; care recipients; career development; caregiver stress; caregiving; cognitive ability; design; disability; disabling disease; economic impact; effective intervention; experience; functional independence; high risk; human centered design; human old age (65+); ideation; improved; improved functioning; informal caregiver; innovation; instrumental activity of daily living; meetings; member; mental state; mortality; mortality risk; open label; physical conditioning; physically handicapped; programs; protocol development; prototype; psychological distress; skills; social

Project Summary Co-occurring physical and cognitive impairments are an important public health concern in older adults with Alzheimer's Disease and Related Dementias (ADRD) leading to: decreased functional independence and increased mortality. Caregiving for persons with co-occurring ADRD and physical disability is a direct risk factor for nursing home placement for care recipients, and a source of chronic physiologic stress for caregivers resulting in poor health, lost income, physical burden, psychological distress, social isolation and for those most distressed, increased risk of mortality. Thus, it is important to maintain and improve the cognitive and functional ability of older adults with ADRD and their caregivers. The majority of studies for physical interventions in older adults with cognitive impairment focus on: (1) ADRD in later stages, (2) nursing home and long-term care facility residents instead of home-based settings, and (3) few outcomes directly measured physical function (ADLs, IADLs) with geriatric standards of care. The scientific gap is a physical intervention in older adults with cognitive impairment which focuses on: (1) ADRD in earlier stages, (2) home-based settings, and (3) outcomes directly measuring function with Katz ADLs and Lawton's IADLs. The CAPABLE program is currently implemented in more than 30 sites across 16 states and uses the expertise of a Registered Nurse (RN), Occupational Therapist (OT), and Handyworker (HW) to address the home environment and strengths of older adults with disability to improve function, however excludes persons with ADRD. The purpose of this study is to address the needs of older adults with co-occurring ADRD and physical disability and their caregivers with a human centered design (HCD) program, CAPABLE-Family, using the Verbrugge and Jett Disablement Process Model as the theoretical framework. The long term-goal is to offer CAPABLE-Family at CAPABLE sites across the nation, providing benefits to a broader range of older adults. The specific aims are: SA1: To adapt the CAPABLE program to focus on meeting the needs of older adults with co-occurring ADRD and physical disabilities and their caregivers (CAPABLE-Family), and SA2: To evaluate the acceptability, feasibility, and preliminary effect size of CAPABLE-Family in older. In SA1, the dissertation study, the applicant seeks to identify caregiver and care recipient needs, such as: disability, environmental challenges, pain, depression, polypharmacy, provider communication needs, and caregiver burden. This study aligns with the NIA's mission to include research on chronic disabling, and degenerative diseases of aging, with a particular focus on AD; on multiple morbidities, on individual behavioral changes with aging, and on caregiving. The 1-year protocol development includes: contextual qualitative research, synthesis/ideation, and prototype testing from HCD with n=10 dyads, 10 RNs, and 10 OTs. Phases 4/5 provide clinical trials research experience directed by the Primary Mentor. This research contributes to the development of a goal-directed human-centered behavioral intervention for older adults.

项目摘要 同时发生的身体和认知障碍是老年人的重要公共卫生问题 阿尔茨海默氏病和相关痴呆症（ADRD）导致：功能独立性下降和 死亡率增加。同时发生和身体残疾的人的照顾者是直接危险因素 用于护理接收者的疗养院安置，以及护理人员的长期生理压力来源 健康状况不佳，收入失去，身体负担，心理困扰，社会孤立以及最大的人 苦恼，死亡风险增加。因此，维持和改善认知和功能很重要 ADRD及其护理人员的老年人的能力。大多数用于较老的物理干预措施的研究 认知障碍的成年人重点关注：（1）在后期，（2）疗养院和长期护理机构 居民而不是基于家庭的设置，（3）很少有结果直接测量身体功能（ADL，， IADLS）具有老年护理标准。科学差距是对认知老年人的身体干预 重点关注的障碍：（1）在早期阶段，（2）家庭设置和（3）直接结果 用Katz ADL和Lawton的IADL测量功能。当前有能力的程序在 跨16个州的30多个站点，并使用注册护士（RN），职业治疗师的专业知识 （ot），以及处理者（HW）解决家庭环境和残疾老年人的优势 提高功能，但是不包括ADRD的人。这项研究的目的是满足需求 患有同时发生的ADRD和身体残疾的老年人及其护理人员以人为中心 设计（HCD）程序，功能室，使用Verbrugge和Jett禁用过程模型作为 理论框架。长期目标是在全国各地有能力的网站提供能力的家庭， 为更广泛的老年人提供好处。具体目的是：SA1：适应能干的 计划专注于满足同时发生的ADRD和身体残疾及其的老年人的需求 护理人员（能干的家庭）和SA2：评估可接受性，可行性和初步效果大小 能够在年龄较大的家庭中。在SA1，论文研究中，申请人试图识别护理人员和护理 接收者需求，例如：残疾，环境挑战，痛苦，抑郁，多药，提供者 沟通需求和护理人员负担。这项研究符合NIA的使命，包括 慢性残疾和衰老的退化性疾病，特别关注AD；关于多种病态， 随着衰老和照料而变化的个人行为变化。一年协议的开发包括： 上下文定性研究，合成/构思和原型测试，来自n = 10个二元组，10个RN， 和10个OT。阶段4/5提供了由主要导师指导的临床试验研究经验。这项研究 有助于为老年人开发以人为中心的行为干预的发展。