Self-Care TALK to Promote AD Spousal Caregiver Health

描述（由申请人提供）：目前美国估计有450万人患有阿尔茨海默病（AD）或相关的痴呆症，这一数字在未来将急剧增加。大多数阿尔茨海默病患者在家中由非正式的护理员照顾，这些护理员为他们的家人或朋友提供无偿援助。照顾是一项挑战，照顾者往往会产生负面结果，包括抑郁、紧张和其他健康和福祉中断。护理人员被建议“照顾好自己”，但却没有得到关于如何做到这一点的指导，而且可能缺乏资源来照顾他们共存的个人健康需求。照顾患有阿尔茨海默病的配偶的老年人处于特别高风险的环境中，需要支持来维持他们的健康。在照顾过程的早期提供自我照顾的指导可以促进照顾者的健康。本研究的目的是检验高级执业护士与配偶照顾者之间的自我护理教育与支持伙伴关系（自我护理谈话）在减轻压力、提高健康自我效能感和促进健康感知方面的有效性。本研究的具体目的是确定a)自我照顾伙伴关系对照顾压力和自我效能的影响，以及对健康结果的影响，以及b)照顾压力和自我效能对健康的中介作用。采用随机、治疗/比较、重复测量实验设计来测试干预措施与常规护理相比的有效性，该干预措施适用于过去2年内诊断为AD的老年人（至少60岁）、配偶照顾者（n=82）。自我照顾讲座以电话方式提供，以了解照顾责任的要求。每周进行六次对话，以发现健康信念，并确定当前和期望的自我保健活动。核心内容包括：养成健康的习惯，建立自尊，关注积极的一面，避免角色过载，沟通和建立意义。基本内容是标准化的，但每个护理人员的对话是个性化的。笔记本提供有关自我护理的额外信息。假设与常规护理组相比，干预组在第8周和第24周时经历更少的压力，更多的自我效能感，并报告更好的健康状况。通过自我保健促进健康是AD护理人员新干预措施的适当重点。

DESCRIPTION (provided by applicant): An estimated 4.5 million individuals in the U.S. currently live with Alzheimer's Disease (AD) or a related dementia, and this number will increase dramatically in the future. Most persons with AD are cared for at home by informal carers who provide non-paid assistance for their family member or friend. Caregiving is challenging and carers often have negative outcomes, including depression, strain and other disruptions in health and well-being. Carers are advised to 'take care of yourself, yet receive little direction regarding how to do this and may lack resources to attend to their coexisting personal health needs. Older adults who have adopted a caregiving role for a spouse with AD are in a particularly high-risk context, and need support to maintain their health. Providing guidance about self-care early in the caregiving trajectory may foster health among carers. The overall aim of the proposed study is to test the effectiveness of a health-promoting self- care education and support partnership (Self-Care TALK) between advanced practice nurses and spouse caregivers in reducing strain, enhancing self-efficacy related to health and in promoting improved perception of health. Specific aims of the study are to determine a) the effect of the self-care partnership on caregiving strain and self-efficacy, and on health outcomes, and b) the mediating effects of caregiving strain and self- efficacy on health. A randomized, treatment/comparison, repeated-measures experimental design is used to test the effectiveness of the intervention compared to usual care for older (at least 60 years), spouse caregivers (n=82) of persons diagnosed with AD in the previous 2 years. Self-Care TALK is provided using a telephone-based approach in recognition of the demands of caregiving responsibilities. Six weekly conversations are used to discover health beliefs and identify current and desired self-care activities. Core content includes: practicing healthy habits, building self-esteem, focusing on the positive, avoiding role overload, communicating, and building meaning. Basic content is standardized, but conversations are individualized for each carer. A notebook provides additional information about self-care. The intervention group is hypothesized to experience less strain, more self-efficacy, and report better health at 8 and 24 weeks, compared to the usual care group. Promoting health through self-care is an appropriate focus for new interventions with AD caregivers.