Assessing preferences for everyday living in the nursing home: reliability and co

评估疗养院日常生活的偏好：可靠性和合作性

• 批准号: 8191004
• 负责人: Kimberly S VanHaitsma
• 金额: $ 20.38万
• 依托单位: POLISHER RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8191004
• 关键词: Address; Affective; Anxiety; Area; Behavior; Behavioral; Caring; Cognitive; Communities; Complex; Comprehensive Health Care; Dementia; Development; Device or Instrument Development; Elderly; Ensure; Equation; Equipment and supply inventories; Family; Family member; Focus Groups; Foundations; Frail Elderly; Frequencies; Future; Goals; Guidelines; Health; Hordeolum; Impaired cognition; Individual; Interview; Knowledge; Lead; Life; Literature; Logistic Regressions; Logistics; Long-Term Care; Measurement; Measures; Medical; Mental Depression; Methodology; Methods; Modeling; NIH Program Announcements; Nursing Homes; Outcome; Pain; Participant; Patient Self-Report; Personality Traits; Persons; Phase; Population; Proxy; Quality of life; Regulation; Reporting; Research; Sampling; Shapes; Source; Symptoms; Techniques; Testing; Time; United States National Institutes of Health; Work; base; behavioral/social science; care delivery; care preference; design; functional disability; information gathering; innovation; instrument; intervention program; person centered; preference; programs; psychologic; psychosocial; research study; response; social; trend

DESCRIPTION (provided by applicant): Current trends in long-term care, in concert with CMS Quality of Life guidelines, call for a shift in focus to "person-centered care". Evolving conceptualizations of optimal care in the nursing home (NH) are emphasize the need to "know the person" in order to deliver individualized, holistic care. However, incorporating the elder's perspective as a central component in shaping care delivery depends on having a comprehensive and reliable instrument that can gather this information effectively. Currently, no such assessment instrument is available. Knowledge of a resident's everyday life preferences is the foundation on which ongoing individualized care planning is based. Despite this centrality, the reliability of preferences for care has not been assessed in a NH sample. The purpose of this study is to develop a comprehensive, assessment instrument that incorporates NH residents' views of what preference items are most important to them, assess the reliability of preference responses over time, and to examine predictors of changes in resident preferences. In Phase 1 (n=80), this study will use cognitive interviewing techniques to adapt the Preference for Everyday Living Inventory (PELI), originally designed for community dwelling elders, to ensure its applicability to frail residents in NHs, including those with mild to moderate cognitive impairment. In addition, Phase 1 will test the one week reliability of the instrument and cull unreliable items. Using this newly adapted instrument, Phase 2 (n=300) will address which preferences are most and least important to residents and the reliability of preferences over a three month period for NH residents. Multivariate and logistic regression, as well as structural equations models will be used to examine relationships between reliability in preference responses and hypothesized predictor variables suggested from preliminary studies by this research team and the literature. Focus group participants (n=40) will enable us to examine sources of changes in preference responses from the resident's perspective. We will also examine exploratory hypotheses related to examine concordance between family proxy and resident preference responses. The completion of the proposed project will lead to the submission of an R01 proposal testing the PELI embedded in an intervention program designed to ameliorate behavioral and affective disturbances in persons with dementia residing in NHs. The primary specific aims are: 1) Adapt PELI to frail elders residing in NHs using cognitive interviewing (CI) techniques; examine one week test-retest reliability; and cull unreliable items; 2) Identify the most and least significant areas of everyday preferences from the perspective of NH residents, both with and without cognitive impairment; 3) Quantitatively assess the reliability of preference responses of NH residents over a 3-month period and test hypothesized relationships between predictors and resident changes in preference responses; and 4) Qualitatively examine response reliability issues from residents' perspective. Exploratory aim: Examine the concordance between resident-rated preferences and family member proxy ratings of resident preferences. PUBLIC HEALTH RELEVANCE: This primary goal of this study is to redesign and test the reliability of a measure of psychosocial preferences for everyday living in a frail nursing home population. Measurement development and reliability determination are necessary first steps in the ultimate goal of using this measure to enhance holistic individualized care to nursing home residents.

描述（由申请人提供）：长期护理的当前趋势与 CMS 生活质量指南相一致，呼吁将重点转向“以人为本的护理”。疗养院 (NH) 中最佳护理的概念不断发展，强调需要“了解人”，以便提供个性化、整体护理。然而，将老年人的观点作为制定护理服务的核心组成部分取决于是否有一个可以有效收集这些信息的全面可靠的工具。目前还没有这样的评估工具。了解居民的日常生活偏好是持续个性化护理计划的基础。尽管具有这种中心性，但护理偏好的可靠性尚未在 NH 样本中进行评估。本研究的目的是开发一种全面的评估工具，其中纳入新罕布什尔州居民对哪些偏好项目对他们最重要的看法，评估随时间推移偏好反应的可靠性，并检查居民偏好变化的预测因素。 在第一阶段（n=80）中，本研究将使用认知访谈技术来调整最初为社区居住老年人设计的日常生活偏好清单（PELI），以确保其适用于 NH 中体弱的居民，包括那些患有轻度至中度认知障碍的人。此外，第一阶段将对仪器进行为期一周的可靠性测试，剔除不可靠的项目。使用这种新调整的工具，第二阶段 (n=300) 将确定哪些偏好对居民最重要和最不重要，以及 NH 居民三个月内偏好的可靠性。多元和逻辑回归以及结构方程模型将用于检查偏好响应的可靠性与本研究小组和文献的初步研究中建议的假设预测变量之间的关系。焦点小组参与者（n = 40）将使我们能够从居民的角度检查偏好反应变化的来源。我们还将研究与检查家庭代理和居民偏好反应之间的一致性相关的探索性假设。拟议项目的完成将导致提交 R01 提案，测试嵌入干预计划的 PELI，该干预计划旨在改善居住在 NH 的痴呆症患者的行为和情感障碍。 主要具体目标是： 1) 使用认知访谈 (CI) 技术使 PELI 适应居住在 NH 中的体弱老年人；检查一周重测的可靠性；并剔除不可靠的物品； 2) 从 NH 居民的角度确定日常偏好最重要和最不重要的领域，无论有或没有认知障碍； 3) 定量评估 NH 居民在 3 个月内偏好反应的可靠性，并测试预测变量与居民偏好反应变化之间的假设关系； 4）从居民角度定性检验响应可靠性问题。探索性目标：检验居民偏好评分与居民偏好的家庭成员代理评分之间的一致性。 公共健康相关性：本研究的主要目标是重新设计和测试体弱疗养院人群日常生活心理社会偏好衡量指标的可靠性。测量的开发和可靠性的确定是使用该测量来增强疗养院居民的整体个性化护理的最终目标所必需的第一步。