Preventing Aggression in Veterans with Dementia

预防患有痴呆症的退伍军人的攻击行为

• 批准号: 8305962
• 负责人: Mark E. Kunik
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-05-01 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8305962
• 关键词: Address; Advocate; Affect; Aggressive behavior; Agitation; Alzheimer' s Disease; Antipsychotic Agents; Area; Attention; Behavior Therapy; Behavioral; Books; Boxing; Caregiver Burden; Caregivers; Caring; Chronic; Clinic; Communication; Dementia; Development; Diagnosis; Discipline of Nursing; Distress; Educational Materials; Event; Family; Funding; Goals; Grant; Haloperidol; Health Services; Home environment; Incidence; Injury; Institutionalization; Intervention; Life; Medical; Memory; Mental Depression; Mental disorders; Methods; Modeling; Moods; Morbidity - disease rate; Multimedia; Outcome; Pain; Patients; Persons; Pharmaceutical Preparations; Play; Practice Guidelines; Prevalence; Preventive; Primary Health Care; Problem behavior; Provider; Randomized; Randomized Controlled Trials; Recruitment Activity; Research; Research Personnel; Risk; Risk Factors; Role; Sampling; Severities; Telephone; Testing; United States Food and Drug Administration; Veterans; aggression prevention; base; clinical practice; cohort; cost; depressive symptoms; evidence base; improved; injury burden; innovation; mortality; novel strategies; olanzapine; prevent; primary outcome; psychoeducational; psychoeducational intervention; psychologic; psychosocial; secondary outcome; skills

6. PROJECT SUMMARY/ABSTRACT Project Background/Rationale Dementia is one of the most costly chronic conditions in the VA.1 In 2008, 175,621 VA patients had a dementia diagnosis; and the prevalence will increase to 218,017 in 2017.1 Although dementia is primarily defined by memory disturbances, many financial and psychosocial costs are associated with its frequent concurrent medical disorders and psychological/behavioral disturbances. The 2008 Dementia Steering Committee recommended that the VHA fund more research on nonpharmacologic interventions to address behavioral disturbances that occur in 80% of persons with dementia. The investigators of this study have a sustained record of scientific findings that point to the urgent need for new approaches to address aggression, which occurs in 40% of Veterans with dementia and often is not addressed,2 leading to increased institutionalization, injuries, and use of antipsychotic medications.3 A recently completed HSR&D IIR grant4 (IIR 01-159-2), "Causes and Consequences of Aggression in Persons with Dementia," found that pain was among the strongest predictors of aggression.5 The prevalence of pain in persons with dementia is known to be about 50%.6 Project Objectives/Aims Innovative approaches are urgently needed to replace the model of treating aggression with tranquilizing medications. No medications are more than modestly efficacious for treating aggression in persons with dementia. However, antipsychotic medications are commonly prescribed, despite limited efficacy and "black- box" warnings of the increased mortality and morbidity associated with these medications in persons with dementia. We have developed an innovative, psychoeducational intervention that aims to prevent the development of aggression in dementia patients with pain and is guided by empirical evidence regarding mutable risk factors for aggression. As such, the objectives of this proposal are to assess whether this intervention, Preventing Aggression in Veterans with Dementia (PAVeD), 1) decreases incidence of aggression; 2) decreases pain and depression; 3) decreases caregiver burden and improves the caregiver- patient relationship; 4) increases pleasant events; and 5) decreases injuries, use of antipsychotic medication, and nursing-home use. Project Methods The proposed project is a randomized, controlled trial of PAVeD, a 6-8 session, home-based psychoeducational, caregiver/patient intervention. We will recruit 220 dyads (patients with mild-to-moderate dementia and pain who receive care in primary care clinics, and a primary caregiver). Dyads will be randomized to the PAVeD intervention or to an enhanced usual primary care condition (EU-PC). PAVeD uses didactics, role-playing, and multimedia (e.g., books and DVDs). The 6-8 modules will include 4 core modules that address recognizing and treating pain, increasing pleasant activities, and improving patient-caregiver communication. Two to 4 additional elective sessions, selected according to the needs of the dyad, further enhance skills related to these core topics. The EU-PC will include providing the patient and caregiver educational materials on dementia and pain, notifying the primary care provider of the patient's level of pain, and 8 weekly supportive telephone calls to caregivers. The PAVeD group will also receive all EU-PC components.

6.项目总结/摘要 项目背景/理由 痴呆症是VA最昂贵的慢性疾病之一。1 2008年，175，621名VA患者患有痴呆症 2017年患病率将增加到218，017。1虽然痴呆症主要由以下因素定义： 记忆障碍，许多经济和心理社会成本与其频繁并发 医学障碍和心理/行为障碍。2008年痴呆症指导委员会 建议VHA资助更多的非药物干预研究，以解决行为问题， 80%的痴呆症患者会出现这种紊乱。这项研究的研究人员对 一系列科学发现表明，迫切需要采取新的方法来解决侵略问题， 发生在40%的退伍军人痴呆症，往往没有得到解决，2导致增加机构， 伤害和使用抗精神病药物。3最近完成了HSR&D IIR赠款4（IIR 01-159-2）， “痴呆症患者攻击行为的原因和后果”发现，疼痛是 攻击性最强的预测因子。5已知痴呆症患者疼痛的患病率约为 百分之五十。 项目目标/宗旨 迫切需要创新的方法来取代用镇静剂治疗攻击的模式 药物治疗没有任何药物对治疗有攻击性的人有适度的效果。 痴呆然而，抗精神病药物是常见的处方，尽管疗效有限，“黑色- 方框”警告：与这些药物相关的死亡率和发病率增加， 痴呆我们开发了一种创新的心理教育干预措施，旨在防止 伴有疼痛的痴呆患者的攻击性发展，并受到以下经验证据的指导： 攻击性的可变风险因素。因此，本建议的目的是评估 干预，预防老年痴呆症退伍军人的攻击（PAVeD），1）降低 攻击; 2）减少疼痛和抑郁; 3）减少照顾者的负担，改善照顾者- 患者关系; 4）增加愉快事件;和5）减少伤害，抗精神病药物的使用， 和疗养院使用。 项目方法 拟议的项目是一个随机对照试验PAVeD，6-8届，家庭为基础的 心理教育、看护者/患者干预。我们将招募220对患者（轻度至中度 在初级保健诊所接受护理的痴呆和疼痛患者，以及初级护理人员）。二元组将是 随机分配至PAVeD干预组或增强型常规初级护理条件（EU-PC）组。PAVeD用途 教学法、角色扮演和多媒体（例如，书籍和DVD）。6-8个模块将包括4个核心模块 解决识别和治疗疼痛，增加愉快的活动，并改善病人护理 通信根据二分体的需要选择2至4个额外的选修课， 提高与这些核心主题相关的技能。EU-PC将包括为患者和护理人员提供 关于痴呆症和疼痛的教育材料，通知初级保健提供者患者的疼痛程度， 以及每周8次给护理人员的支持性电话。PAVeD集团还将获得所有EU-PC 件.