BEHAVIORAL CASE MANAGEMENT FOR ALZHEIMER'S DISEASE CAREGIVERS

有关照看的理论模型和实证研究表明 护理压力源使家庭面临更高的风险水平 心理、社会和心理方面的负担和较差的幸福感 身体健康结果。对文献的回顾表明， 痴呆症照顾者的身体和心理健康似乎是 具体表现为：(1)缺乏照顾者的社会支持和(2) 挑战患者的问题行为，包括脱离， 走神等行为过度，以及以下行为缺陷 日常生活中基本和工具性活动的执行困难 (ADLS/IADLS)。之前的照顾者干预研究表明 支持小组、照顾者社会支持和行为管理 可以对照顾者的精神和身体产生积极的影响 发病率。然而，可以预见的是，最有效的干预措施 涉及全面的治疗组件，可解决多个 照顾他人的压力源。治疗效果似乎得到了提高 根据照顾者的需要进行个性化治疗并提供 通过面对面和电话联系。 我们建议进行行为案例管理(BCM)干预 包括两个以患者为中心的干预计划，以解决患者问题 脱离和问题行为，也是以照顾者为重点的 加强照顾者社会积极影响的干预计划 支持。这项研究的目标1是评估BCM的效果 对照顾者福祉的干预计划通过使用 一套全面的措施。我们采用的特定BCM计划 基于完善的压力过程模型和经过验证的行为 痴呆症护理的方法。这项研究的目标2是评估 BCM干预方案对痴呆患者行为的影响 病人自己。我们希望调查这些计划的影响 关于行为缺陷(ADL/ADL)，例如 颠覆性定位和患者抑郁。这项研究的目标3是 促进特定类型的积极影响(工具和 情感)和社交领域(社交网络和满意度 支持并研究它们对照顾者结果的影响。评估和 将教授应对技能，以增加照顾者对 对支持的满意度。将实施BCM干预 通过一系列战略排序的家庭和基于电话的 与护理者/患者二人组的联系。BCM的影响 干预措施将与基于电话的最低限度干预进行比较 电话支持(MTS)。

Theoretical models and empirical studies of caregiving suggest that caregiving stressors place families at increased risk for high levels of burden and poorer well-being in such areas as psychological, social, and physical health outcomes. A review of the literature indicates that dementia caregivers' physical and psychological well-being appear to be compromised specifically by (1) lack of caregiver social support and (2) challenging patient problem behaviors, including disengagement, behavioral excesses such as wandering, and behavioral deficits such as difficulty performing basic and instrumental activities of daily living (ADLs/IADLs). Previous caregiver intervention studies suggest that support groups, caregiver social support, and behavior management each can have a positive impact on caregivers' psychiatric and physical morbidity. Predictably, however, the most effective interventions involve comprehensive treatment components that address multiple caregiving stressors. Treatment effectiveness appears to be enhanced when treatment is individualized to the caregiver's needs and delivered via face-to-face and telephone contacts. We propose to conduct a Behavioral Case Management (BCM) intervention consisting both patient-focused intervention programs to address patient disengagement and problems behaviors, and also a caregiver-focused intervention program to enhance the positive impact of caregiver social support. Aim 1 of the study is to evaluate the effects of the BCM's intervention programs on caregiver well-being through the use of a comprehensive set of measures. The specific BCM programs that we employ are based on a well-developed stress process model and proven behavioral approaches to dementia care. Aim 2 of the study is to assess the effects of the BCM intervention programs on the behaviors of the dementia patients themselves. We wish to investigate the impact of the programs on behavioral deficits (ADLs/ADLs), behavioral excesses such as disruptive localization, and patient depression. Aim 3 of the study is to foster the positive impact of specific types (instrumental and affective) and domains (social network and satisfaction) of social support and study their influence on caregiver outcomes. Appraisal and coping skills will be taught to increase caregivers acceptance of and satisfaction with support. The BCM intervention will be implemented through a series of strategically sequenced in-home and telephone-based contacts with the caregiver/patient dyad. The effects of the BCM intervention will be compared with those of a telephone-based Minimal Telephone Support (MTS).