Intervention for Disabling Anxiety in Older Adults Injured By Falls

描述（由申请人提供）：“对因跌倒受伤的老年人失能焦虑的干预”本申请的目标是使自己成为一名独立的研究者，开发针对因跌倒受伤的老年人失能焦虑的干预措施。每年，数以百万计的美国老年人因跌倒而受到生命威胁或严重伤害。尽管人们越来越认识到跌倒的心理后果，但创伤知识的进步尚未应用于这一人群。我的四个培训目标是：(1)加深我对可能使老年患者治疗复杂化的既存因素的理解；(2)拓宽对老年患者物理康复过程的了解；(3)加强在老年患者干预措施开发中整合精神药理学知识的能力；(4)获得设计临床干预措施疗效研究所需的技能和数据。在JoAnn Difede博士和Martha Bruce博士的指导下，将利用威尔康奈尔医学院的机构资源，以及来自纽约校区的各种专业人士、患者和社区的参与，完成拟议的课程、与内部和外部顾问的会议和研究。在获奖期间，我将进行三个目标的研究：(1)将认知行为暴露疗法（ET）应用于患有致残性焦虑型创伤后应激障碍（PTSD）、亚综合征型创伤后应激障碍或因跌倒而导致的特定恐惧症（害怕跌倒）的老年人。ET将包括八个环节，包括心理教育、放松训练、认知重组、行为激活和暴露。修改将包括在家中提供治疗和鼓励健康行为（与卫生保健专业人员沟通、加强社会支持、参与有价值的活动和练习预防跌倒）；(2)对该人群进行开放治疗的可行性试验。潜在的参与者（通过重症监护和创伤科招募）将在出院回家后的三个月内完成基线评估。提供知情同意的符合条件的参与者（N = 32）将接受ET，并在治疗完成和三个月随访时重新评估。我将评估a)参与者的可用性，b)登记和保留，c)治疗的可接受性，以及4)干预对诊断、症状和生活质量的影响；(3)对放松训练进行随机对照试验。提供知情同意的符合条件的参与者（N = 64）将按照类似的程序随机分配到放松训练或控制条件（放松训练）。本研究将为进一步了解三个要素提供机会：a)随机化的可行性，b)控制条件的可行性，以及c)探索ET的主要功效。拟议的项目最终将申请资助一项完全随机对照试验。这将是ET对因跌倒而导致失能焦虑的老年人的首次试验。

DESCRIPTION (provided by applicant): "Intervention for disabling anxiety in older adults injured by falls" The goal of this application is to establish myself as an independent investigator who develops interventions for disabling anxiety in older adults injured by falls. Each year, millions of older Americans experience a threat to life or serious injury because of a fall. Despite increasing recognition of the psychological consequences of falling, advances in knowledge of trauma have yet to be applied to this population. My four training goals will be: (1) To deepen my understanding of pre-existing factors that may complicate treatment of older patients; (2) To broaden my familiarity with the process of physical rehabilitation for older patients; (3) To strengthen my ability to integrate knowledge of psychopharmacology in the development of interventions for older patients; and (4) To acquire the skills and data needed to design studies of the efficacy of clinical interventions. The proposed program of coursework, meetings with internal and external consultants, and research will be completed under the mentorship of JoAnn Difede, Ph.D., and Martha Bruce, Ph.D., M.P.H. I will use institutional resources at Weill Cornell Medical College as well as the participation of diverse professionals, patients, and communities accessible from its New York City campuses. I will conduct research during the award period that will have three aims: (1) To adapt cognitive- behavioral exposure therapy (ET) for use with older adults with disabling anxiety-full posttraumatic stress disorder (PTSD), subsyndromal PTSD, or specific phobia (fear of falling) resulting from a fall. The ET will consist of eight sessions incorporating psychoeducation, relaxation training, cognitive restructuring, behavioral activation, and exposure. Modifications will include delivering the treatment at home and encouraging healthy behaviors (communication with healthcare professionals, strengthening social support, engaging in valued activities, and practicing falls prevention); (2) To conduct an open-treatment feasibility trial of ET with this population. Potential participants (recruited via the Division of Critical Care and Trauma) will complete a baseline assessment within three months of returning home from the hospital. Eligible participants who provide informed consent (N = 32) will receive the ET and be re-assessed upon completion of treatment and at three month follow-up. I will evaluate the a) availability of participants, b) enrollment and retention, c) acceptability of the treatment, and 4) the impact of the intervention on diagnosis, symptoms, and quality of life; (3) To conduct a randomized controlled pilot test of the ET. Eligible participants who provide informed consent (N = 64) will be randomized to either ET or a control condition (Relaxation Training) following similar procedures. This study will provide an opportunity to understand three further elements: a) the feasibility of randomization, b) feasibility of the control condition, and c) explore the primary efficacy of the ET. The proposed program will culminate in an application to fund a fully randomized controlled trial. This will be the first trial of ET for older adults with disabling anxiety resulting from a fall. PUBLIC HEALTH RELEVANCE: Although several effective treatments for posttraumatic stress and specific phobia exist, little work has been done to apply these to the needs of older adults, especially those injured by accidents such as falls. This career award will enable me to pursue a program of coursework, mentorship, and research that will allow me to make a significant contribution to this issue. During the award period, I will conduct adapt an evidence-based treatment to make it suitable for older adults with disabling anxiety as a result of being injured by a fall, test the feasibility of the treatment on approximately 96 older patient, and refine both the treatment and research approach in readiness for more intensive study of the treatment's efficacy with a larger sample of patients.