RAMP?: A Mental Health Intervention for Long-Term Care Residents with Dementia

描述（由申请人提供）：本R34提案的长期目标是发展基于住院医生辅助蒙特梭利计划（RAMP(tm)），作为一种干预措施，由长期护理（LTC）环境中的工作人员实施，以促进痴呆症患者的心理健康。如果RAMP（tm）在这个发展项目中显示出希望，将寻求一项随机临床试验的支持，以证明这种干预对LTC痴呆症患者的公共卫生效益优于其他团体活动。RAMP（tm）是一种新颖的干预措施，在该干预措施中，早期痴呆症患者被培训为小群晚期痴呆症患者的活动领导者。在一项小规模试验中，RAMP（tm）已被证明可以增加活动期间的参与度和积极影响。本研究的目的是进一步发展和试验RAMP（tm）。该研究分为两个阶段，分别是开发、测试和比较由工作人员实施的方法与由研究人员实施的干预措施。这两个阶段将涉及相同的设计、样本量、测量和分析。在每个阶段，培训和实施将在大克利夫兰地区的四个不同的长期护理机构进行。在每个阶段，将使用RAMP（tm）条件（早期痴呆症患者将担任蒙台梭利基础活动的小组组长）和对照条件（早期痴呆症患者将担任非蒙台梭利基础小组活动的小组组长）。这两种情况将在两个地点平行发生，然后在另外两个地点平行发生。在第一阶段，研究人员将培训16名患有早期痴呆症的人，让他们为患有痴呆症的成年人（RAMP（tm）条件）领导基于蒙台梭利的阅读小组活动或基于蒙台梭利的文字游戏活动，或者根据替代的非蒙台梭利原则领导小组活动（Zgola, 1987; 1999）。每位领导者将领导一组由五名患有晚期痴呆症的常驻参与者（“玩家”）组成的小组。将收集措施来评估实施和参与者（领导者和参与者）的结果。第一阶段的结果将用于修改和改进培训程序。在第二阶段，RAMP（TM）和非蒙台梭利干预将在另外四个长期护理设施中实施，不同之处在于，小组领导的培训将由LTC的工作人员（而不是研究人员）提供，他们参加了培训师培训计划。本研究的目的是：1)通过RAMP（tm）干预，使早期痴呆的长期护理居民成为晚期痴呆居民的团体活动领导者；2)创建类似的干预措施，使早期痴呆居民能够担任较晚期痴呆居民非蒙台梭利小组活动的小组活动领导者；3)评价RAMP（tm）与对照组干预对长期护理居民心理健康指标的影响；4)开发培训师培训模式，使长期护理人员能够实施RAMP（tm）和对照组干预；5)评估在一段时间的培训后，由LTC工作人员实施（而不是由研究人员实施）RAMP（tm）和对照组干预所产生的效果。

DESCRIPTION (provided by applicant): The long-term objective of this R34 proposal is to develop Resident Assisted Montessori-based Programming (RAMP(tm)) as an intervention that is implemented by staff in long-term care (LTC) settings to promote the mental health of residents with dementia. If RAMP(tm) shows promise in this developmental project, support will be sought for a randomized clinical trial to demonstrate the public health benefits of this intervention over other group activities for persons with dementia in LTC. RAMP(tm) is a novel intervention in which residents with early dementia are trained as activity leaders for small groups of residents with more advanced dementia. In a small-scale trial, RAMP(tm) has been shown to increase engagement and positive affect during activities. The purpose of the present study is to further develop and pilot test RAMP(tm). The study is designed with two phases to develop, test and compare an staff-implemented approach with intervention as implemented by research personnel. Both phases will involve the same design, sample sizes, measures and analyses. In each phase, training and implementation will occur at four distinct long-term care facilities in the Greater Cleveland area. In each phase, a RAMP(tm) condition (in which persons in early stage dementia will serve as group leaders for Montessori-based activities) and a control condition (in which persons in early stage dementia will serve as group leaders for non-Montessori-based group activities) will be used. Both conditions will occur at two sites in parallel, then in another two sites in parallel. In Phase 1, research staff will train sixteen persons with early stage dementia to lead either a Montessori-based reading group activity or a Montessori-based word game activity for adults with dementia (RAMP(tm) condition) or to lead group activities based upon alternate, non-Montessori principles (Zgola, 1987; 1999). Each leader will lead a group of five resident participants (?players?) with more advanced dementia. Measures will be collected to assess implementation and participant (both leader and player) outcomes. Results of Phase 1 will be used to modify and improve training procedures. In Phase 2, RAMP(TM) and the non-Montessori intervention will be implemented in four additional long-term care facilities, with the difference that training of group leaders will be provided by LTC staff (rather than research personnel) who take part in a train-the-trainer program. The objectives of the study are: 1) to enable long-term care residents with early-stage dementia to serve as group activity leaders for residents with more advanced dementia through the RAMP(tm) intervention; 2) to create a similar intervention that will enable residents with early dementia to serve as group activity leaders for non-Montessori-based group activities for residents with more advanced dementia; 3) to assess the effects produced by RAMP(tm) and the comparison group intervention on mental health indices of long-term care residents; 4) to develop a train-the-trainer model enabling long-term care staff to implement RAMP(tm) and the comparison group intervention; and 5) to assess effects produced by RAMP(tm) and the comparison group intervention when implemented by LTC staff (as opposed to implementation by research personnel) following a period of training.