Supporting Family Caregivers with Technology for Dementia Home Care (FamTechCare)

描述(由申请人提供)：这项临床试验将测试FamTechCare干预，该干预使用基于家庭视频监控的多学科专业指导，以支持家庭照顾者管理痴呆症患者(PWD)的行为。家庭在家中为残障人士提供大部分护理。然而，照料的压力是如此之大，以至于增加了照顾者的发病率和死亡率。经常导致养老院安置的破坏性行为放大了压力。家庭视频监控使专家能够评估PWD的行为，识别先兆因素，推荐具体的干预措施，并随后评估照顾者的结果。FamTechCare使用新技术将家庭照顾者与专家联系起来，寻求在管理破坏性行为方面的指导，支持在家中继续照看，同时减少照看的负面影响。来自爱荷华大学医院和诊所以及堪萨斯大学阿尔茨海默病中心的照顾者-PWD二元组(N=88)将被随机分配到干预组或对照组。这两组人都将使用家庭监测装置记录3个月的日常护理期间的行为。值得注意的是，这项新技术捕捉到了行为前15分钟的信息，从而记录了行为的触发和前兆。干预组的视频将被自动上传到HIPAA安全的互联网网站上，供团队每周审查，并向行为管理的照顾者提供家庭反馈。时间和注意力等值的对照组每周都会接到护士的电话，但他们录制的视频将在3个月后保留下来供审查和反馈。这项研究建立在PI的CTSA研究的基础上，该研究验证了使用家庭监控和对行为的专业观察来指导照顾者管理家庭护理的可行性。我们的团队发现，视频数据对于识别先兆因素、推荐具体干预措施以及随后评估反应至关重要。照顾者对破坏性行为的减少以及他们自己的压力和负担感到非常满意。这项研究扩展了IRB批准的协议、程序、HIPAA安全软件接口，以及用于基于互联网的团队会议和护理人员反馈的协议。研究的目的是根据家庭观察确定干预措施，以帮助照顾者进行行为管理。组间对结果的影响，包括PWD破坏性行为和照顾者负担以及其他负面结果，将使用线性混合模型进行比较。我们将评估翻译的易用性和满意度、成本效益以及影响翻译实践可能性的因素。这是第一项测试直接观察和即时反馈的新技术的研究，使家庭能够在家中管理PWD行为，同时减少照顾者的压力和发病率。技术将照顾者与个性化的专家指导联系起来，承认他们角色的重要性和负担。这项研究涉及美国国立卫生研究院的任务和2012年解决阿尔茨海默病目标的国家计划，整合了在干预措施中促进采用和使用老龄服务技术的战略，以减少负面照顾者结果，这是一个日益严重的公共卫生问题。

DESCRIPTION (provided by applicant): This clinical trial will test the FamTechCare intervention that uses multidisciplinary professional guidance based on in-home video monitoring to support family caregivers in managing behaviors of persons with dementia (PWD). Families provide the majority of care for PWD at home. However the stress of caregiving is so significant that it increases caregiver morbidity and mortality. Stress is magnified by disruptive behaviors that frequently lead to nursing home placement. In-home video monitoring allows experts to assess behaviors of PWD and to identify antecedents, recommend specific interventions, and subsequently evaluate caregiver outcomes. FamTechCare uses new technology to link family caregivers to experts for guidance in managing disruptive behaviors, supporting continued care at home while reducing the negative effects of caregiving. Caregiver-PWD dyads (N=88) from the University of Iowa Hospital and Clinics and the University of Kansas Alzheimer's Disease Center will be randomly assigned to intervention or control groups. Both groups will record behaviors during daily care for 3 months using a home monitoring unit. Notably, this new technology captures 15 minutes prior to the behavior, thus recording behavior triggers and precursors. Intervention group videos will be auto-uploaded to a HIPAA-secure Internet site for weekly team review with in-home feedback to caregivers in behavior management. The time and attention equivalent control group will receive a weekly phone call from a nurse, but their recorded videos will be held for review and feedback after 3 months. This study builds on the PI's CTSA study that verified feasibility for using in-home monitoring and professional observation of behaviors to guide caregivers in managing care at home. Our team found the video-data essential to identify antecedents, recommend specific interventions, and subsequently evaluate responses. Caregivers were highly satisfied with reductions in disruptive behaviors and their own stress and burden. This study expands the IRB-approved protocols, procedures, HIPAA-secure software interface, and protocols for internet-based team meetings and caregiver feedback. Study aims are to identify interventions, based on in-home observations, to assist caregivers in behavior management. Between-group effects on outcomes, including PWD disruptive behaviors and caregiver burden and other negative outcomes will be compared using linear mixed modeling. We will evaluate ease of use and satisfaction, cost-efficiency, and factors influencing likelihood of translation into practice. Thi is the first study to test new technology for direct observation and immediate feedback to empower families to manage PWD behaviors at home while reducing caregiver stress and morbidity. Technology links caregivers to individualized expert guidance, acknowledging the importance and burden of their role. This study addresses NIH missions and the 2012 National Plan to Address Alzheimer's disease goals, integrating strategies to promote adoption and use of aging services technologies in interventions that will reduce negative caregiver outcomes, a growing public health problem.