Evaluating the CG ASSIST Program for Caregiving Dyads

评估针对护理二人组的 CG ASSIST 计划

• 批准号: 8202409
• 负责人: Patricia C. Griffiths
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8202409
• 关键词: Activities of Daily Living; Address; Age; Aging; Area; Attention; Bathing; Beds; Blinded; Caregivers; Caring; Chronic; Communities; Complement; Control Groups; Crossover Design; Dependency; Devices; Distress; Effectiveness; Elderly; Face; Family member; Friends; Hand; Health; Home environment; Home visitation; House Call; Impairment; Injury; Institutionalization; Intervention; Interview; Lead; Life; Long-Term Care; Measures; Mental Depression; Methods; Modality; Modification; Nature; Nursing Homes; Outcome; Outcome Assessment; Participant; Patient Self-Report; Personal Satisfaction; Persons; Phase; Pilot Projects; Population; Preventive; Process; Program Effectiveness; Protocols documentation; Quality of life; Randomized; Randomized Controlled Trials; Rehabilitation therapy; Relative (related person); Reporting; Research; Research Design; Research Personnel; Risk Factors; Safety; Schedule; Self-Help Devices; Services; Specialist; Spouses; Sterile coverings; System; Technology; Testing; Time; Training; Training Programs; Veterans; Visit; assistive device/technology; base; care systems; caregiver education; caregiving; clinically relevant; cost; design; disability; effectiveness trial; experience; falls; follow-up; four-arm study; improved; instrument; meetings; member; preference; premature; programs; rural area; skills; skills training; standard of care; symposium; telehealth

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.

描述（由申请人提供）： 介绍和目的：拟议的为期四年的随机对照试验的主要目标是记录为依赖日常生活活动（ADL）的老年退伍军人及其非正式护理人员提供动手技能培训和辅助技术（AT）/环境改造计划将改善康复过程（即，技能）和成果（即，任务期间的安全性），并且对二分体的两个成员具有有益的直接和间接效果。次要目标是确定该计划对退伍军人和护理人员主观幸福感（抑郁症，生活质量）的影响，并比较两种有效的实施方式传统的面对面方法和实时交互式远程视频会议的相对有效性。研究计划。该研究将在老年退伍军人（> 60岁）中进行，这些退伍军人患有行动障碍，生活在社区中，并依赖非正式护理人员提供ADL帮助，包括移动、转移或位置改变。本研究将采用改良的随机对照交叉设计，包括4个研究组和3个结局评估期。在首次家庭访视之前，受试者将被随机分配至立即干预组（IIG）或延迟干预/对照组（DICG），然后在这些组中随机分配至干预模式（面对面与电视视频）。方法.将对180名退伍军人进行家庭访谈，以获得基线，自我报告的措施，使用标准化的，有效的工具来衡量退伍军人的需求，过程和结果。辅助技术专家（ATS）的家访将反映面谈访问（1周内），通过观察功能任务独立客观地评估需求。将在1个月（T2）和2个月（T3）后重新评价二元组，以确定变化。T1评估后，IIG中的患者将接受ATS的2次额外家访，以（1）提供干预和（2）加强干预。第二个设盲ATS将进行T2结局评估，这也将作为DCG的重复基线。然后在DCG中对二联重复干预时间表，然后对两组进行T3最终评估。干预护理评估技能集和个性化支持通过培训或CG协助计划最近经历了可行性测试在VA RR&D试点研究。干预措施包括：（a）提供辅助技术和简单的家居改造，以促进日常生活能力的发展;（B）采用符合家庭需要和偏好以及家庭环境特点的标准化方案，对家庭成员进行适当使用设备和正确执行任务的培训。临床相关性。支持和协助护理人员为退伍军人提供护理，帮助他们在适当的地方养老，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意义。 公共卫生相关性： 这项研究将导致更好地了解日常生活活动（ADL）的依赖性需要在老年退伍军人和他们的非正式照顾者，是预防和“促进”的性质与ADL援助的挑战可能会导致受伤，福尔斯，应变，痛苦和过早的制度化。维持护理人员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。通过培训或CG ASSIST计划进行的技能组合和个性化支持的护理评估旨在帮助退伍军人及其护理人员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留在自己的家中。