Medication Administration and Chemical Restraints in Family Caregiving for Alzheimer's Disease and Related Dementia

阿尔茨海默病和相关痴呆症家庭护理中的药物管理和化学限制

• 批准号: 10396112
• 负责人: Carolyn E Ziminski Pickering
• 金额: $ 57.25万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 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 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10396112
• 关键词: Address; Adverse effects; Advisory Committees; Aging; Algorithms; Alzheimer' s Disease; Alzheimer' s disease related dementia; Behavioral Symptoms; Caregivers; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Chemicals; Clinical; Clinical assessments; Congresses; Data; Dementia; Dementia caregivers; Distress; Dose; Elder Abuse; Enrollment; Family Caregiver; Family Practice; Foundations; Frequencies; Future; Goals; Happiness; Health Professional; High Prevalence; Incidence; Intervention; Knowledge; Longitudinal Studies; Measurement; Medical; Medication Management; Meta-Analysis; Morbidity - disease rate; Outcome; Patients; Pattern; Persons; Pharmaceutical Preparations; Public Health; Randomized; Records; Reporting; Research; Research Priority; Role; Safety; Surveys; Symptoms; Typology; United States National Institutes of Health; Work; adverse outcome; base; biological adaptation to stress; care recipients; caregiver education; caregiver stress; caregiving; contextual factors; diaries; disorder prevention; evidence base; experience; family caregiving; high risk; innovation; medication administration; mortality; response; restraint; screening; symposium; symptom management; therapy design

Project Abstract All persons with Alzheimer’s disease and related dementias (ADRD) will experience behavioral symptoms of dementia (BSD). Management of BSD is one of the most frequent daily tasks caregivers perform, which includes deciding when to administer an “as needed” medication to address BSD. Non-pharmacologic strategies are the recommended first-line approach to manage BSD, though “as needed” medications can be warranted when non- pharmacologic strategies fail and the BSD are either causing distress to the care recipient or jeopardizing the physical safety of the care recipient or caregiver. Conversely, chemical restraint means a drug is being administered to make care more convenient for the caregiver, not because it is medically indicated. Our team has reported that 22% of ADRD family caregivers inappropriately administer medications as chemical restraints. Importantly, there are no evidence-based indications for pharmacotherapeutic management of a patient symptom for the benefit of a caregiver, aside from safety. Thus, this high prevalence is concerning, and represents an emerging public health crisis and major gap in knowledge. Given the novelty of this newly described phenomenon, the purpose of this study is to describe patterns of medication administration, chemical restraint, and associated mortality outcomes in ADRD family caregiving. To address this, we will conduct a 31- day micro-longitudinal study in which family caregivers (N=300) complete daily diaries describing BSD management including use of non-pharmacologic strategies and medications. These data will be supplemented with personal characteristics of the caregivers obtained through an enrollment survey, clinical characteristics of care recipients found in their EHR and combined with vital records data on the care recipient’s mortality. This proposed study will implement an innovative algorithm to classify medication administration as medically indicated, potentially inappropriate and chemical restraint in consideration of non-pharmacologic strategies tried, safety concerns, and distress of the care recipient (Aim 1). This study will also characterize patterns of chemical restraint to create typologies and determine characteristics of chemical restraint users (Aim 2), and determine the relationship between chemical restraint use and 1-year mortality of the care recipient (Aim 3). This study is the first step towards creating sensitive clinical assessments to identify situations at high risk of adverse outcomes related to caregiving practices. This foundational work will support a long-term research goal to evaluate if randomizing caregivers to screening for chemical restraint results in greater reduced morbidity and mortality for care recipients than the observed harms.

项目摘要 所有患有阿尔茨海默病和相关痴呆症 (ADRD) 的人都会出现以下行为症状： 痴呆症（BSD）。 BSD 的管理是护理人员最常执行的日常任务之一，其中包括 决定何时“按需”服用药物来治疗 BSD。非药物策略是 推荐的治疗 BSD 的一线方法，尽管在非治疗情况下可以保证“按需”药物治疗 药物策略失败，BSD 要么给护理接受者造成痛苦，要么危及 照顾者或照顾者的人身安全。相反，化学限制意味着药物正在被 进行管理是为了使护理人员的护理更加方便，而不是因为有医学上的指示。我们的团队 据报道，22% 的 ADRD 家庭护理人员不恰当地使用药物作为化学约束剂。 重要的是，没有针对患者药物治疗管理的循证适应症 除了安全之外，症状也是为了护理人员的利益。因此，这种高患病率令人担忧，并且 代表了一场新出现的公共卫生危机和知识方面的重大差距。鉴于这个新产品的新颖性 所描述的现象，本研究的目的是描述药物管理、化学药物的模式 ADRD 家庭护理中的克制和相关死亡率结果。为了解决这个问题，我们将进行 31- 日间微观纵向研究，其中家庭护理人员 (N=300) 完成描述 BSD 的每日日记 管理包括使用非药物策略和药物。这些数据将被补充 通过入组调查获得护理人员的个人特征、临床特征 被护理者在其电子病历中发现并结合有关被护理者死亡率的重要记录数据。这 拟议的研究将实施一种创新算法，将药物管理分类为医疗 指出，考虑到尝试的非药物策略，可能存在不适当的化学限制， 安全问题以及被照顾者的痛苦（目标 1）。这项研究还将表征化学模式 创建类型并确定化学约束使用者的特征（目标 2），并确定 化学约束的使用与护理接受者 1 年死亡率之间的关系（目标 3）。这项研究是 创建敏感的临床评估以确定不良风险高风险的情况的第一步 与护理实践相关的结果。这项基础工作将支持长期研究目标 评估随机化护理人员进行化学抑制筛查是否可以更大程度地降低发病率和 受护理者的死亡率高于观察到的危害。