Intervention for Disabling Anxiety in Older Adults Injured By Falls

描述(申请人提供)：“老年人跌倒致残焦虑的干预”本申请的目的是将我自己确立为一名独立的调查者，开发针对老年人跌倒致残焦虑的干预措施。每年，数以百万计的美国老年人因跌倒而受到生命威胁或严重受伤。尽管人们越来越多地认识到跌倒的心理后果，但创伤知识的进步尚未应用于这一人群。我的四个培训目标将是：(1)加深我对可能使老年患者的治疗复杂化的先前存在因素的理解；(2)扩大我对老年患者身体康复过程的熟悉；(3)加强我在为老年患者制定干预措施时整合精神药理学知识的能力；以及(4)获得设计临床干预效果研究所需的技能和数据。拟议的课程、与内部和外部顾问的会议以及研究将在JoAnn Difede博士和Martha Bruce博士、M.P.H.的指导下完成。我将使用威尔·康奈尔医学院的机构资源以及从纽约校区进入的不同专业人员、患者和社区的参与。在获奖期间，我将进行三个目标的研究：(1)调整认知行为暴露疗法(ET)，用于患有完全创伤后应激障碍(PTSD)、亚综合征创伤后应激障碍(PTSD)或因跌倒而产生的特定恐惧症(恐惧跌倒)的老年人。ET将由八个课程组成，包括心理教育、放松训练、认知重建、行为激活和暴露。改进措施将包括在家中提供治疗，并鼓励健康行为(与医疗专业人员沟通，加强社会支持，参与有价值的活动，练习预防跌倒)；(2)在这一人群中进行ET的开放治疗可行性试验。潜在参与者(通过重症护理和创伤司招募)将在从医院回家后三个月内完成基线评估。提供知情同意的符合条件的参与者(N=32)将接受ET，并在完成治疗和3个月的随访时重新评估。我将评估a)参与者的可用性，b)登记和保留，c)治疗的可接受性，以及4)干预对诊断、症状和生活质量的影响；(3)进行ET的随机对照试点测试。提供知情同意的符合条件的参与者(N=)将被随机分配到ET或对照条件(放松训练)，遵循类似的程序。这项研究将提供一个进一步了解三个要素的机会：a)随机化的可行性，b)对照条件的可行性，c)探索ET的主要疗效。拟议的计划最终将申请资助一项完全随机对照试验。这将是对因跌倒而导致失能焦虑的老年人进行的首次ET试验。 公共卫生相关性：尽管存在几种治疗创伤后应激障碍和特定恐惧症的有效方法，但很少有工作将这些方法应用于老年人的需求，特别是那些因跌倒等意外受伤的人。这一职业奖项将使我能够继续进行课程作业、指导和研究计划，这将使我对这一问题做出重大贡献。在获奖期间，我将进行循证治疗，使其适用于因跌倒而致残焦虑的老年人，在大约96名老年患者身上测试该治疗的可行性，并改进治疗和研究方法，以准备在更大的患者样本中更深入地研究该治疗的有效性。

DESCRIPTION (provided by applicant): "Intervention for disabling anxiety in older adults injured by falls" The goal of this application is to establish myself as an independent investigator who develops interventions for disabling anxiety in older adults injured by falls. Each year, millions of older Americans experience a threat to life or serious injury because of a fall. Despite increasing recognition of the psychological consequences of falling, advances in knowledge of trauma have yet to be applied to this population. My four training goals will be: (1) To deepen my understanding of pre-existing factors that may complicate treatment of older patients; (2) To broaden my familiarity with the process of physical rehabilitation for older patients; (3) To strengthen my ability to integrate knowledge of psychopharmacology in the development of interventions for older patients; and (4) To acquire the skills and data needed to design studies of the efficacy of clinical interventions. The proposed program of coursework, meetings with internal and external consultants, and research will be completed under the mentorship of JoAnn Difede, Ph.D., and Martha Bruce, Ph.D., M.P.H. I will use institutional resources at Weill Cornell Medical College as well as the participation of diverse professionals, patients, and communities accessible from its New York City campuses. I will conduct research during the award period that will have three aims: (1) To adapt cognitive- behavioral exposure therapy (ET) for use with older adults with disabling anxiety-full posttraumatic stress disorder (PTSD), subsyndromal PTSD, or specific phobia (fear of falling) resulting from a fall. The ET will consist of eight sessions incorporating psychoeducation, relaxation training, cognitive restructuring, behavioral activation, and exposure. Modifications will include delivering the treatment at home and encouraging healthy behaviors (communication with healthcare professionals, strengthening social support, engaging in valued activities, and practicing falls prevention); (2) To conduct an open-treatment feasibility trial of ET with this population. Potential participants (recruited via the Division of Critical Care and Trauma) will complete a baseline assessment within three months of returning home from the hospital. Eligible participants who provide informed consent (N = 32) will receive the ET and be re-assessed upon completion of treatment and at three month follow-up. I will evaluate the a) availability of participants, b) enrollment and retention, c) acceptability of the treatment, and 4) the impact of the intervention on diagnosis, symptoms, and quality of life; (3) To conduct a randomized controlled pilot test of the ET. Eligible participants who provide informed consent (N = 64) will be randomized to either ET or a control condition (Relaxation Training) following similar procedures. This study will provide an opportunity to understand three further elements: a) the feasibility of randomization, b) feasibility of the control condition, and c) explore the primary efficacy of the ET. The proposed program will culminate in an application to fund a fully randomized controlled trial. This will be the first trial of ET for older adults with disabling anxiety resulting from a fall. PUBLIC HEALTH RELEVANCE: Although several effective treatments for posttraumatic stress and specific phobia exist, little work has been done to apply these to the needs of older adults, especially those injured by accidents such as falls. This career award will enable me to pursue a program of coursework, mentorship, and research that will allow me to make a significant contribution to this issue. During the award period, I will conduct adapt an evidence-based treatment to make it suitable for older adults with disabling anxiety as a result of being injured by a fall, test the feasibility of the treatment on approximately 96 older patient, and refine both the treatment and research approach in readiness for more intensive study of the treatment's efficacy with a larger sample of patients.