Intervention for Disabling Anxiety in Older Adults Injured By Falls

描述（由申请人提供）：“干预老年人因福尔斯跌倒受伤的致残性焦虑”本申请的目标是建立自己作为一个独立的研究者谁开发干预老年人因福尔斯跌倒受伤的致残性焦虑。每年，数百万美国老年人因跌倒而受到生命威胁或严重伤害。尽管人们越来越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治疗复杂化的既存因素的理解;（2）扩大我对老年患者物理康复过程的熟悉程度;（3）加强我将精神药理学知识整合到老年患者干预措施开发中的能力;以及（4）获得设计临床干预有效性研究所需的技能和数据。拟议的课程计划，与内部和外部顾问的会议以及研究将在JoAnn Difede博士的指导下完成，和玛莎布鲁斯博士M.P.H.我将利用威尔康奈尔医学院的机构资源，以及来自纽约市校园的各种专业人士、患者和社区的参与。我将在获奖期间进行研究，将有三个目标：（1）调整认知行为暴露疗法（ET）用于患有致残性焦虑症的老年人-完全创伤后应激障碍（PTSD），亚综合征PTSD，或因跌倒引起的特定恐惧症（害怕跌倒）。ET将包括八个课程，包括心理教育，放松训练，认知重建，行为激活和暴露。修改将包括在家提供治疗和鼓励健康行为（与医疗保健专业人员沟通、加强社会支持、参与有价值的活动以及预防福尔斯跌倒）;（2）进行开放治疗ET可行性试验该人群。潜在参与者（通过重症监护和创伤科招募）将在出院回家后三个月内完成基线评估。提供知情同意书的合格受试者（N = 32）将接受ET，并在治疗完成后和3个月随访时重新评估。我将评估a）参与者的可用性，B）入组和保留，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的随机对照初步试验。提供知情同意书的合格受试者（N = 64）将按照类似程序随机分配至ET组或对照组（放松训练）。本研究将提供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，以及c）探索ET的主要疗效。该计划将最终申请资助一项完全随机对照试验。这将是第一次对因跌倒而导致失能焦虑的老年人进行ET试验。 公共卫生相关性：虽然有几种有效的治疗创伤后应激障碍和特定恐惧症的方法，但很少有人将这些方法应用于老年人的需要，特别是那些因福尔斯等事故受伤的人。这个职业奖将使我能够追求的课程，指导和研究，这将使我能够对这个问题做出重大贡献的计划。在获奖期间，我将进行调整以证据为基础的治疗，使其适用于因跌倒受伤而致残焦虑的老年人，在大约96名老年患者身上测试治疗的可行性，并完善治疗和研究方法，以便在更大样本的患者中进行更深入的治疗效果研究。

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.