Improving Care Planning and Well-being in Older Adults with Macular Degeneration

描述（由申请人提供）：作为老年人中不可逆失明和严重视力丧失的主要原因，黄斑变性（AMD）影响美国超过1000万人。人口老龄化导致一些人预测AMD的流行。丧失独立性和有价值的活动使AMD患者患抑郁、焦虑和残疾的风险增加。许多人都很悲观，不愿意为与视力丧失相关的未来住房和流动性问题做计划。患者对AMD的情绪和行为反应可能会加剧该疾病的长期健康威胁，并导致可预防的医疗保健费用，生产力损失和家庭成员负担。我们提出了一项心理社会干预的随机对照试验，旨在实现三个心理健康促进目标：（1）增加情感幸福感，（2）改善未来前景，（3）保护或增强当前和面向未来的功能。我们的预防性问题解决干预（PREPSI）是一个简短的，标准化的问题解决治疗的修改，培训参与者识别和明确定义当前和未来的问题，然后生成，评估，选择和实施解决方案。此外，我们还提供以小组为基础的疾病管理教育。我们的目标是改善风险感知、选项意识、偏好形成和对未来问题的积极决策，例如，护理环境、社会需求和住所调整。我们的研究计划的长期目标是通过对预防性未来规划进行基础和转化研究来提高成年后期的生活质量。这项拟议的研究检查了PREPSI对400名60岁及以上的AMD患者的影响，这些患者的最佳矫正视力为20：60。他们将被随机分配到8个PREPSI会议与硕士水平的培训师或加强注意力控制臂，其中医学生进行“生活和健康审查。“所有参加研究的学生将接受四个视觉教育课程及资源信息。对治疗状况不知情的评估者将在整个干预过程中的4个时间点以及24个月随访中每6个月测量一次心理健康（主要结局）、未来展望、日常功能和未来护理准备（次要结局）。我们的干预措施将改善AMD患者的生活质量，并可能为其他慢性疾病的治疗提供信息。PREPSI被设计成可移动的，并且可以在低视力诊所由经过最少培训的工作人员实施。下一步可能包括多地点试验或传播到眼科诊所网络。该提案建立在PI的NIA K 01基础上，重点关注PFC对老年人主观幸福感和日常功能影响的观察性研究。这是申请人第一次提交R 01。公共卫生相关性：黄斑变性（AMD）是老年人中不可逆失明和严重视力丧失的主要原因;其下坡过程被充分描述，并且许多患者遭受随后的情绪困扰、消极的未来前景和功能障碍。有效的解决问题、规划未来的护理和居住需求以及疾病管理教育可以解决AMD的情绪和行为影响，并防止随之而来的不良健康后果，如福尔斯、急诊室就诊和医疗保险费用增加。因为大多数AMD患者不主动计划长期护理或未来的居住需求，所以本申请提出了心理教育健康促进干预的随机对照试验，“预防性问题解决训练”，以确定问题解决和未来计划干预是否可以增强患有这种和其他慢性进行性疾病的患者的情绪健康、功能和计划。

DESCRIPTION (provided by applicant): As the leading cause of irreversible blindness and severe vision loss among older adults, Age-related Macular Degeneration (AMD) affects more than 10 million people in the US. The aging of the population has led some to forecast an epidemic of AMD. Loss of independence and valued activities places AMD patients at increased risk for depression, anxiety, and disability. Many are pessimistic and reluctant to plan for future housing and mobility problems associated with vision loss. Patients' emotional and behavioral responses to AMD can exacerbate the long-term health threat of the disease and contribute to preventable health care costs, loss of productivity, and burden to family members. We propose a randomized controlled trial of a psycho-social intervention that addresses three mental health promotion goals: (1) increase emotional well-being, (2) improve future outlook, and (3) protect or enhance current and future-oriented functioning. Our Preventive Problem Solving Intervention (PREPSI) is a short, standardized modification of problem- solving therapy that trains participants to identify and clearly define current and future problems, and then generate, evaluate, choose, and implement solutions. In addition, we provide group-based education on disease-management. We aim to improve risk perception, awareness of options, preference formation, and active decision-making for future concerns, e.g., care settings, social needs, and residential adjustments. The long-term goal of our research program is to improve quality of life in late adulthood by conducting basic and translational research on preventive future planning. The proposed study examines the effects of the PREPSI on 400 AMD patients 60 and older, who have best corrected vision acuity of 20:60 in their better eye. They will be randomized to 8 PREPSI sessions with master's level trainers or to an enhanced attention control arm in which medical students conduct "Life and Health Review." All study participants will receive 4 vision education classes and resource information. Assessors blind to treatment condition will measure Psychological Well-being (primary outcome), Future Outlook, Everyday Functioning, and Preparation for Future Care (secondary outcomes) at 4 time points throughout the intervention and every 6 months in a 24 month follow-up. Our intervention will improve AMD patients' quality of life and could inform programs for other chronic diseases. PREPSI is designed to be transportable and could be implemented in low vision clinics by staff with minimal training. Next steps could include multi-site trials or dissemination into eye clinic networks. This proposal builds on a NIA K01 to the PI that focused on observational studies of the effect of PFC on subjective well-being and everyday functioning for older adults. This is the applicant's first R01 submission. PUBLIC HEALTH RELEVANCE: Age-related Macular Degeneration (AMD) is the leading cause of irreversible blindness and severe vision loss among older adults; its down-hill course is well-described, and many patients suffer from subsequent emotional distress, negative future outlook and functional impairments. Effective problem-solving, planning for future care and residential needs, and disease management education could address the emotional and behavioral effects of AMD and prevent the consequent adverse health outcomes, such as falls, emergency room visits and increased Medicare costs. Because most AMD patients do not plan proactively for long-term care or future residential needs, this application proposes a randomized controlled trial of a psycho-educational health- promotion intervention, "Preventive Problem Solving Training" to determine whether problem-solving and future planning interventions can enhance emotional well-being, functioning, and planning in patients with this and other chronic progressive illnesses.