Evaluating the CG ASSIST Program for Caregiving Dyads

描述(由申请人提供)： 前言和目的：这项拟议的为期四年的随机对照试验的主要目标是证明，为依赖日常生活能力(ADL)的老年退伍军人及其非正式照顾者提供动手技能培训和辅助技术(AT)/环境改造计划将导致照看过程(即照看技能)和结果(即任务期间的安全性)与当前护理标准相比的改善，并对双方成员产生有益的直接和间接影响。次要目标是确定该计划对退伍军人和照顾者主观幸福感(抑郁、生活质量)的影响，并比较两种经过验证的实施模式的相对有效性，即传统的面对面方法和实时交互式远程视频会议。研究计划。这项研究将在老年退伍军人(60岁)中进行，他们生活在社区，有行动能力障碍，需要依赖非正式的照顾者提供ADL帮助，涉及行动能力、调动或职位变化。这项研究将采用修改的随机对照交叉设计，包括四个研究臂和三个结果评估期。在第一次家访之前，参与者将被随机分为立即干预组(IIG)或延迟干预/对照组(DICG)，然后在这些组中随机进入干预模式(面对面与远程视频)。方法：研究方法。家庭访谈将与180名经验丰富的护理二人组完成，以获得基线的自我报告的护理需求、过程和结果的测量，使用标准化的、经过验证的工具。辅助技术专家(ATS)的上门访问将与面谈访问(在1周内)相对应，通过观察功能任务来独立和客观地评估需求。DUADS将在一个月(T2)和两个月(T3)后重新评估，以确定变化。在T1评估之后，IIG中的那些将接受ATS的额外2次家访，以(1)提供干预措施和(2)加强干预措施。第二个盲人ATS将进行T2成果评估，这也将作为DICG的重复基线。随后将对DICG中的DIAD重复干预时间表，然后对两组进行T3最终评估。干预。技能集护理评估和个性化支持通过培训或CG协助计划最近在退伍军人管理局RR&D试点研究中进行了可行性测试。干预措施包括：(A)提供辅助技术(AT)和简单的家庭改装，以促进ADL；以及(B)关于适当使用设备和正确执行任务的DYAD培训，使用针对DUAD的需求和偏好以及家庭的环境特征而个性化的标准化协议。临床相关性。支持和协助护理员为退伍军人提供护理，帮助他们就地老化，这对VHA系统以及我们所服务的退伍军人的安全、尊严和生活质量具有重要影响。 公共卫生相关性： 这项研究将有助于更好地了解老年退伍军人及其非正式照顾者的日常生活活动(ADL)依赖需求，并具有预防性和“促进性”的性质，因为ADL援助的挑战可能导致受伤、摔倒、劳累、窘迫和过早住院。维持照顾者及其在家中提供护理的能力对我们的健康和长期护理系统至关重要。技能评估和通过培训或CG援助计划的个性化支持旨在帮助退伍军人及其照顾者进行这些基本的日常生活活动，从而使他们能够保持独立和尊严，并尽可能长时间地安全地呆在自己的家里。

DESCRIPTION (provided by applicant): Introduction and Objective: The primary objective of the proposed four-year randomized, controlled trial is to document that providing a hands-on skills training and assistive technology (AT)/environmental modification program for older veterans who are dependent in activities of daily living (ADLs) and their informal caregivers will result in improvements in caregiving processes (i.e., caregiving skills) and outcomes (i.e., safety during tasks) compared to the current standard of care and have beneficial direct and indirect effects for both members of the dyad. Secondary objectives are to determine the effects of the program on veteran and caregiver subjective well-being (depression, quality of life) and to compare the relative effectiveness of two validated implementation modalities the traditional in-person approach and real-time interactive tele-video conferencing. Research Plan. The study will be conducted with older veterans (>60yrs) with mobility impairments who live in the community and are dependent on an informal caregiver for ADL assistance involving mobility, transfer or positional change. The study will utilize a modified randomized controlled cross-over design with four study arms and three outcome assessment periods. Prior to the first home visit, participants will be randomized to an immediate intervention (IIG) or delayed intervention/control group (DICG) then randomized within those groups to intervention modality (in-person vs. tele-video). Methods. In-home interviews will be completed with 180 veteran caregiving dyads to obtain baseline, self-reported measures of caregiving needs, processes and outcomes using standardized, validated instruments. In-home visits by an assistive technology specialist (ATS) will mirror the interview visits (within 1 week) to independently and objectively assess needs through observation of functional tasks. Dyads will be re-evaluated one (T2) and two (T3) months later to ascertain change. Following T1 assessments, those in the IIG will receive 2 additional home visits from the ATS to (1) deliver the intervention and (2) reinforce the intervention. A 2nd blinded ATS will conduct the T2 outcome assessments which will also serve as a repeat baseline for the DICG. The intervention schedule will then be repeated for dyads in the DICG followed by T3 final assessments for both groups. Intervention. The Caregiving Assessment of Skill Sets & Individualized Support Thru Training or CG Assist program has recently undergone feasibility testing in a VA RR&D pilot study. The intervention consists of (a) provision of assistive technology (AT) and simple home modifications to facilitate ADLs and (b) dyad training on the appropriate use of the devices and proper task execution using standardized protocols individualized to the needs and preferences of the dyad and environmental features of the home. Clinical Relevance. Supporting and assisting caregivers in providing care for veterans to help them age in place has important implications for the VHA system and the safety, dignity and quality of life of the veterans we serve. PUBLIC HEALTH RELEVANCE: This study will lead to a better understanding of activities of daily living (ADL) dependency needs in older veterans and their informal caregivers and is both preventive and "promotive" in nature as challenges with ADL assistance can lead to injuries, falls, strain, distress and premature institutionalization. Sustaining caregivers and their ability to provide care at home is crucial to our health and long-term care systems. The CareGiving Assessment of Skill Sets and Individualized Support thru Training or CG ASSIST program is designed to help veterans and their caregivers with these fundamental activities of daily living thus enabling them to maintain independence and dignity and to remain safely within their own homes for as long as possible.