The Hearthside Book Club: Pioneering Dementia-Level-Appropriate Reading Materials

描述（由申请人提供）：估计有540万美国人目前患有阿尔茨海默病（AD），并且AD病例预计将以惊人的速度上升，因此市场潜力存在于可以帮助治疗和/或规避与该病症相关的挑战性行为的产品，方法和/或培训中。其中一个被证明是有效的方法是使用蒙台梭利活动规划（MAP）。这项研究将涉及进一步发展和完善一个创新的MAP活动称为炉边读书俱乐部TM（HBC），这将是有史以来第一次痴呆症水平的适当阅读材料。对于32个主题中的每个主题，将创建四个不同版本的故事/文章。为痴呆症早期患者编写的“A-级阅读材料”将有30页，以9年级水平编写;为痴呆症中期患者编写的“AA-级阅读材料”将有25页，以6年级水平编写;“AAA级水平故事”为痴呆症晚期患者创作，长度为20页，将以四年级水平编写;最后，“AAAA 年级故事”，为老年痴呆症的晚期阶段的人创建，将是15页长，并在三年级水平写。因此，总共将为这项研究创建128个故事。一半的故事将包含图片。共有120名老年痴呆症患者将参加这项研究。他们将被分配到四组之一：早期组（简易精神状态检查（MMSE）评分为18+），中期组（MMSE，11-17），晚期组（MMSE，5-10）或极晚期组（MMSE<5）。将把参加人居中心会议的人的参与情况与他们参与标准基线活动的情况进行比较。还将比较HBC会议期间的参与情况与阅读圆桌会议（R）（RR）会议期间的参与情况。RR故事是为痴呆症患者设计的，但没有针对不同程度的痴呆症进行调整。关键的近端结局指标包括参与和沟通模式;关键的远端结局指标包括生活质量、抑郁和躁动。将在基线、1个月RR疗程后、1个月无图片HBC疗程后和1个月有图片HBC疗程后进行远端测量。本研究的具体目标是：（1）根据第一阶段的经验教训开发改进的HBC故事;（2）开发足够数量的HBC故事用于两个月的活动规划;（3）为严重晚期痴呆患者（MMSE<5）开发HBC故事;（4）在三类设施中设立阅读小组（疗养院、辅助生活设施和成人日间中心）;（5）检查阅读组的近端和远端效应;（6）检查阅读小组对痴呆症患者沟通模式的影响;（7）检查干预效果是否在三级护理中存在差异;（8）使用第2阶段研究的结果来创建产品的最终上市版本。 公共卫生相关性：据估计，目前有540万美国人患有阿尔茨海默病（AD），预计AD病例将以惊人的速度上升。除了影响患有该病症的人之外，由于护理患有痴呆症的人所需的巨大成本以及由于对患有痴呆症的人的护理者施加的精神和身体压力，AD还呈现出公共卫生问题;因此，迫切需要将参与和刺激患有痴呆症的人的产品和计划，同时减少对护理者的压力。通过为不同程度的痴呆症患者编制特殊阅读材料，拟议项目将有助于满足这一需求。

DESCRIPTION (provided by applicant): An estimated 5.4 million Americans are currently suffering from Alzheimer's disease (AD), and AD cases are expected to rise at an alarming rate, so market potential exists for products, approaches, and/or training that can help treat and/or circumvent the challenging behaviors associated with the condition. One approach that has been shown to be effective involves the use of Montessori Activity Programming (MAP). This study will involve the further development and refinement an innovative MAP activity called the Hearthside Book ClubTM (HBC), which will be the first-ever dementia-level appropriate reading materials. For each of 32 topics, four different versions of a story/essay will be created. Developed for persons in the early stages of dementia, "A- Grade Level Reading Materials" will be 30 pages in length and be written at an 9th grade level; "AA-Grade Level Reading Materials", developed for persons in the Middle Stages of dementia, will be 25 pages in length and will be written at the 6th grade level; "AAA-Grade Level Stories", created for persons in the Late Stages of Dementia, will be 20 pages in length, and will be written at the 4th grade level; finally, "AAAA Grade Level Stories", created for persons in the Very Late Stages of Dementia, will be 15 pages in length, and be written at the 3rd grade level. So, a total of 128 stories will be created for ths study. Half of the stories will contain pictures. A total of 120 older adults with dementia will participate in the study. They will be assigned to one of four groups: the Early Stage Group (Mini-Mental Status Exam (MMSE) score of 18+), the Middle Stage Group (MMSE, 11-17), the Late Stage Group (MMSE, 5-10), or the Very Late Stage Group (MMSE<5). The engagement of persons taking part in HBC sessions will be compared against their engagement in standard, baseline activities. Engagement during HBC sessions will also be compared against engagement in Reading Roundtable(R) (RR) sessions. RR stories are designed for persons with dementia, but are not adjusted for varying levels of dementia. Key proximal outcome measures include engagement and communication patterns; key distal outcome measures include quality of life, depression, and agitation. Distal measures will be taken at baseline, afte one month of RR sessions, after one month of HBC sessions without pictures, and after one month of HBC sessions with pictures. The Specific Aims of the study are: (1) to develop improved HBC stories based upon lessons learned in Phase 1; (2) to develop a enough number of HBC stories for two months of activity programming; (3) to develop HBC stories for persons with severely advanced dementia (MMSE<5); (4) to implement reading groups at three types of facilities (nursing homes, assisted living facilities, and adult day centers); (5) to examine the proximal and distal effects of the reading groups; (6) to examine the effects of the reading groups on communication patterns of persons with dementia; (7) to examine whether the effects of the intervention varies among the three levels of care; and (8) to use results of the Phase 2 study to create a final, market-ready version of the product. PUBLIC HEALTH RELEVANCE: An estimated 5.4 million Americans are currently suffering from Alzheimer's disease (AD), and AD cases are expected to rise at an alarming rate. Besides affecting the person with the condition, AD also presents a public health concern, due to the significant cost required to care for persons with dementia and due to the mental and physical stress placed upon caregivers of persons with dementia; so, there is an urgent need for products and programs that will engage and stimulate persons with dementia, while at the same time reducing the stress on caregivers. Through the development of special reading materials for persons of varying levels of dementia, the proposed project will help meet this need.