Caregiver-based Intervention for Persistent Delirium

描述（由申请人提供）：超过三分之一的住院老年人出现谵妄，其中一半以上的病例谵妄是持续性的。持续性谵妄与患者预后差有关，也会导致护理人员的压力和负担。在过去的5年里，我们一直在进行一项由美国国立卫生研究院资助的随机试验，在急性后熟练护理机构中进行谵妄缓解计划。我们目前的建议建立在我们对持续性谵妄患者及其护理人员的丰富经验之上。我们将进行一项为期15个月的基于护理者干预持续性谵妄（CIPD）的随机试验，将招募48对患者-护理者。患者将在住院期间进行谵妄筛查，如果出现谵妄，将联系护理人员评估资格并提供知情同意。初步筛查后或出院后谵妄持续3天的患者将按2:1的比例随机分为CIPD组和常规组。基于社会认知理论，CIPD将聘请一名老年护理从业者作为健康教练，他将与护理人员一起制定出院前谵妄的个性化健康行动计划。出院后，执业护士将继续每周与护理者一起工作，为期六周，包括两次家访。在这段时间之后，在12周干预期的剩余时间里，将至少每两周进行一次接触。随机分组后2周、6周和12周测量的患者结果将是谵妄症状和ADL功能的改变。照护者的结果将是在同一时间点的负担、自我效能和健康状况的变化。我们建议的试点有以下具体目的：1)确定在持续性谵妄患者中实施以护理者为基础的健康教练干预的可行性；2)对所有入组的护理者进行定性访谈，以更好地了解他们的持续性谵妄经历，并获得如何改进干预的反馈；3)对患者和护理者终点的应计率和效应大小进行初步估计，以便设计一项明确的随机对照试验。如果有希望，我们的研究结果将作为一个决定性试验的试点数据，以测试这种新策略，以改善老年人及其照顾者的弱势群体的健康。

DESCRIPTION (provided by applicant): Over one-third of hospitalized elders develop delirium, and in more than half of these cases, delirium is persistent. Persistent delirium is associated with poor patient outcomes, and also leads to substantial caregiver stress and burden. For the past 5 years, we have been conducting an NIH-funded randomized trial of a Delirium Abatement Program in post-acute skilled nursing facilities. Our current proposal builds upon our extensive experience with patients with persistent delirium and their caregivers. We will conduct a 15-month pilot randomized trial of a Caregiver-based Intervention for Persistent Delirium (CIPD) that will enroll 48 patient-caregiver dyads. Patients will be screened for delirium while inpatients, and if delirious, caregivers will be contacted to assess eligibility and provide informed consent. Patients whose delirium persists for 3 days after the initial screening or until hospital discharge will be randomized to CIPD vs. usual care in a 2:1 ratio. Based on Social Cognitive Theory, the CIPD will employ a gerontological nurse practitioner serving as a health coach who will engage caregivers in developing an individualized health action plan for delirium prior to hospital discharge. After hospital discharge, the nurse practitioner will continue to work with the caregiver at weekly intervals for six weeks, including 2 home visits. After this period, there will be at least biweekly contacts over the remainder of the 12-week intervention period. Patient outcomes will be change in delirium symptoms and ADL function, measured 2, 6, and 12 weeks after randomization. Caregiver outcomes will be change in burden, self-efficacy, and health status at the same time points. Our proposed pilot trial has the following Specific Aims: 1) To determine the feasibility of performing a caregiver-based health coach-mediated intervention in patients with persistent delirium, 2) To perform qualitative interviews of all enrolled caregivers to better understand their experience of persistent delirium and to obtain feedback on how to improve our intervention, and 3) To obtain preliminary estimates of accrual rates and effect sizes for patient and caregiver endpoints to enable the design of a definitive randomized controlled trial. If promising, our findings will serve as pilot data for a definitive trial to test this novel strategy to improve the health of a vulnerable population of elders and their caregivers.