Preparing for future dementia care: A study of hospitalized patient-family dyads

为未来的痴呆症护理做准备：住院患者与家庭二人组的研究

• 批准号: 8784462
• 负责人: Lyndsey Medora Miller
• 金额: $ 4.27万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8784462
• 关键词: Acute; Advocate; Affect; Alzheimer' s Disease; Caregivers; Caring; Cessation of life; Cognitive; Collaborations; Communities; Complex; Cross-Sectional Studies; Data; Decision Making; Dementia; Development; Diagnosis; Disease; Elderly; Ensure; Equilibrium; Family; Family Caregiver; Frequencies; Frontotemporal Dementia; Future; Goals; Health; Hospitalization; Hospitals; Impaired cognition; Individual; Intervention; Intervention Studies; Knowledge; Lewy Body Dementia; Life; Mental Depression; Methods; National Research Service Awards; Neurologic; Nurses; Outcome; Patients; Perception; Persons; Physical Function; Preparation; Process; Provider; Regression Analysis; Research; Research Personnel; Research Training; Risk; Risk Factors; Scientist; Syndrome; Time; Training; United States; Vascular Dementia; caregiving; community setting; design; end of life; executive function; improved; information processing; innovation; insight; multilevel analysis; next generation; preference; pressure; public health relevance; substituted judgment

DESCRIPTION (provided by applicant): Hospitalizations occur three times as often for persons with dementia (PWDs) as for older adults in general. Prior to hospital discharge, important decisions must be made about the PWD's future care. Although PWDs can provide consistent and reliable information, the process of preparing for future care requires additional cognitive abilities including executive function and insight, which decline in dementia. Hospital providers rely upon family caregivers to advocate for the care values of and make surrogate decisions for the PWD, even when PWDs want to participate in their own care planning. Thus, it is important for family caregivers to be congruent with PWDs regarding their care values in order to make decisions that are aligned with the PWD's preferences for future care. The overall goal of this study is to identify PWD-caregiver dyads most at risk of incongruence while in the midst of a health crisis and looming decisions about future dementia care. A descriptive cross-sectional study of 60 dyads will be conducted in the acute care setting. The aims of this study are: 1) To identify the modifiable variables associated with incongruence in PWD and caregiver perceptions of the PWD's care values; 2) To explore the relationship between incongruence in perceptions of the PWD's care values and the caregiver's preparation for future care. Data will be collected from both the PWD and caregiver. Incongruence will be analyzed at the level of the dyad using multilevel modeling. The relationship between preparation for future care and incongruence in perceptions of the PWD's care values will be examined using multiple regression analysis. This study pertains to NINR's focus on research that promotes decision-making for complex treatment and care options in the face of life-threatening illness, including end-of-life care. In addition, as part of an NRSA proposal, this study contributes to the applicant's long-term goal of developing into an independent nurse researcher who is successful in implementing targeted interventions that improve dementia care planning by balancing the needs of family caregivers and the care values of the PWD. In order to ensure that the applicant has the necessary knowledge and expertise to attain this goal, the training plan draws upon the combined expertise of an interdisciplinary team consisting of researchers who are experts in family caregiving, dementia, analytic methods for dyadic data, and hospitalized patients with cognitive impairment. In collaboration with the applicant, the expert team has developed a comprehensive training plan that includes mastery of content related to dementia care values, expertise in multiple analytic approaches, understanding of intervention research, and dissemination. The research and training outcomes of this proposal are aligned with the goals of the NINR, in that it will support the development of the next generation of nurse scientists, enhance innovation, and contribute to the improvement of the care planning process for PWDs and caregivers.

描述（由申请人提供）：一般而言，痴呆症患者（PWDs）的住院率是老年人的三倍。 在出院之前，必须就残疾人的未来护理做出重要决定。虽然残疾人可以提供一致和可靠的信息，但为未来护理做准备的过程需要额外的认知能力，包括执行功能和洞察力，这在痴呆症中会下降。医院提供者依靠家庭护理人员来倡导残疾人的护理价值观，并为残疾人做出替代决定，即使残疾人希望参与自己的护理计划。因此，重要的是，家庭照顾者要与残疾人一致，他们的护理价值观，以作出决定，符合残疾人的偏好，为未来的护理。本研究的总体目标是确定在健康危机和未来痴呆症护理的迫在眉睫的决定中，最有可能出现不一致的PWD-护理者二人组。将在急性护理环境中对60对患者进行描述性横断面研究。本研究的目的是：1）确定与残疾人和照顾者对残疾人的照顾价值观的感知不一致的可修改变量; 2）探讨残疾人的照顾价值观的感知不一致和照顾者对未来照顾的准备之间的关系。将从PWD和护理人员处收集数据。 不一致性将使用多层次模型在二元体水平上进行分析。准备未来的护理和不一致的看法，残疾人的护理价值观之间的关系将采用多元回归分析。这项研究属于NINR的重点研究，促进决策的复杂治疗和护理方案，面对危及生命的疾病，包括临终关怀。此外，作为NRSA提案的一部分，这项研究有助于申请人发展成为一名独立的护士研究人员的长期目标，他们成功地实施了有针对性的干预措施，通过平衡家庭照顾者的需求和PWD的护理价值观来改善痴呆症护理规划。为了确保申请人拥有实现这一目标所需的知识和专业知识，培训计划利用了由家庭成员、痴呆症、二元数据分析方法和认知障碍住院患者专家组成的跨学科团队的综合专业知识。专家团队与申请人合作，制定了全面的培训计划，包括掌握与痴呆症护理价值观相关的内容，多种分析方法的专业知识，对干预研究的理解以及传播。该提案的研究和培训成果与NINR的目标一致，因为它将支持下一代护士的发展。 科学家，加强创新，并有助于改善残疾人和护理人员的护理规划过程。