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

项目摘要 在家庭团聚的情况下，阿尔茨海默病和相关痴呆症（ADRD）患者更有可能 老年人遭受虐待和忽视（EAN）的比例高于独居或不需要护理援助的老年人。 虐待和忽视老年人（EAN）的定义是一个人在信任关系中犯下的行为， 对老年人的健康和福祉造成损害的实际或增加的风险。EAN由不同的亚型组成， 身心虐待和忽视大约一半的痴呆症患者的家庭照顾者自我 报告至少有这三种EAN亚型之一。该建议评估了基于证据的远程指导 干预，护理抗拒行为互联网培训（CuRB-IT），以提高家庭照顾者的应对技能 减少虐待和忽视老人（EAN）。CRB包括ADRD患者为抵抗或 拒绝护理援助，例如拒绝张开嘴进行口腔护理或使用身体攻击。我们 远程辅导干预（CuRB-IT），通过教授实用的 管理CRB的策略，有效地减少了CRB相关的护理人员的痛苦。我们将测试 CuRB-IT在延迟干预随机临床试验中的多时间序列方法。照顾者 立即和延迟干预组（N=266）将完成4波仪器完成， 描述基线、3个月、6个月时21天内CRB和EAN频率的日记调查， 9个月。延迟干预的护理人员将每周收到短信，以减少夸大的干预效果 22在3个月的随访后，延迟干预组将 接受CuRB-IT干预。这种设计使我们能够最大限度地提高检查疗效（组间）的能力， 作用机制和干预延迟（组内）。因此，我们提出以下具体目标：1） 测试在线护理抗拒行为辅导干预在降低EAN频率方面的有效性（a） 在实验组（立即干预组）与对照组（延迟干预组）之间 （组间）和（B）从干预前到干预后的人内。2)测试假设的机制 通过多层次结构方程模型来评估CRB-应力之间的关系 评估，使用CuRB-IT问题为重点的应对策略和EAN;和3）检查干预衰减， 3-和干预后6个月，以确定干预的性能并告知加强剂的时间表 sessions.我们还将评估CuRB-IT干预措施在预防家庭使用EAN方面的有效性 作为一个探索性的目标。该提案直接解决了由联合国确定的高度优先研究差距， NIH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 专注于翻译实践设置，如UAB卫生系统的照顾者丧亲服务热线 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.