Apathy in Nursing Home Residents with Dementia: Impact of Caregiver Communication

患有痴呆症的疗养院居民的冷漠：护理人员沟通的影响

• 批准号: 9993187
• 负责人: Ying-Ling Jao
• 金额: $ 19.42万
• 依托单位: PENNSYLVANIA STATE UNIVERSITY, THE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-15 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9993187
• 关键词: Address; Affective; Alzheimer' s Disease; Alzheimer' s disease related dementia; Behavior; Behavioral Symptoms; Caregivers; Caring; Characteristics; Clinical Trials; Code; Communication; Data; Data Set; Dementia; Emotional; Environment; Environmental Risk Factor; Funding; Goals; Health; Impaired cognition; Individual; Intervention; Kale - dietary; Lead; Linear Models; Measures; Mental Depression; Modeling; Moods; Motivation; Nerve Degeneration; Neurobehavioral Manifestations; Nonverbal Communication; Nursing Homes; Outcome; Patients; Pattern; Persons; Quality of Care; Quality of life; Self Care; Services; Severities; Symptoms; Testing; Time; Training; United States National Institutes of Health; Variant; base; dementia care; experience; functional decline; improved; innovation; interest; mortality; neuropsychiatric symptom; person centered; pleasure; routine care; secondary analysis; social

ABSTRACT Apathy is a symptom that presents with a deficit of motivation, reduced goal-directed behaviors and responsiveness to environmental stimulation, and a flat mood. Nearly 50% of nursing home (NH) residents live with Alzheimer’s disease and related dementias (ADRD) and 84% of NH residents with ADRD demonstrate apathy. Apathy is a significant problem because it is associated with considerable negative outcomes, including accelerated cognitive and functional decline, lower quality of life, poorer illness outcomes, greater need for institutional care, and higher mortality. Caregiver-resident communication is fundamental for daily care activities in NHs and significantly impacts quality of care. Interacting with residents with ADRD can be challenging, due to their difficulty in understanding, remembering, and verbally expressing themselves. Interacting with residents with ADRD and apathy is especially challenging, because they are socially withdrawn, do not take initiative, and rely on others’ prompts to engage in interactions. Interventions to improve caregiver communication and person-centered activities have been shown to reduce some behavioral symptoms in ADRD. It is unclear to what extent that apathy symptoms differ over time for the same individual and across different individuals. This information will help to clarify the potential extent to which apathy can be changed. This proposed study will address this gap by analyzing variations in the magnitude and duration of apathy symptoms within and between individuals. Further, it is unknown how caregiver communication impacts apathy. Thus, this study will examine the impact of caregiver communication on apathy. This is a secondary analysis using existing video data from a completed NIH-funded clinical trial. The dataset comprises video observations from 46 residents during caregiver-resident interactions in 12 NHs. Videos were recorded during routine care activities at multiple time points over 5-9 months. This study aims to examine variations in the magnitude and duration of apathy symptoms and examine the concurrent and sequential relationships between caregiver communication and apathy symptoms. First, we will test variations of apathy pattern across residents, within the same resident across interactions, and within each interaction. Next, we will analyze four aspects of caregiver communication qualities: 1) communication topic, 2) emotional tone, 3) person-centered verbal communication, and 4) person-centered non-verbal communication. We anticipate that person-centered communication approaches will be associated with lower levels of apathy symptoms. This is the first study examining the impact of caregiver communication on apathy. Findings will help identify approaches to improve caregiver communication, which can be used to develop interventions to reduce apathy, improve resident health outcomes, quality of life, and reduce mortality for NH residents with ADRD. This study will help promote care quality and efficiency for ADRD and achieve the major goal of the 2017 National Plan to Address Alzheimer’s Disease.

摘要 冷漠是一种症状，表现为缺乏动力，减少目标导向行为， 对环境刺激的反应性和平淡的情绪。近50%的养老院（NH）居民生活在 阿尔茨海默病和相关痴呆症（ADRD）和84%的NH居民与ADRD显示， 冷漠冷漠是一个重要的问题，因为它与相当多的负面结果有关， 包括加速认知和功能衰退，生活质量下降，疾病结果较差， 需要机构护理和更高的死亡率。护理人员与住院医师的沟通是日常护理的基础 活动在NHS和显着影响护理质量。与患有ADRD的居民互动可以 由于他们在理解、记忆和口头表达方面的困难，他们具有挑战性。 与患有ADRD和冷漠的居民互动尤其具有挑战性，因为他们是社会性的。 孤僻，不主动，依赖他人的提示进行互动。干预措施来改善 护理人员的沟通和以人为中心的活动已被证明可以减少一些行为 ADRD的症状目前还不清楚在多大程度上，冷漠症状不同，随着时间的推移，同一个人 and across横过different不同individuals个人.这些信息将有助于澄清冷漠的潜在程度， 变了这项拟议的研究将通过分析以下方面的幅度和持续时间的变化来解决这一差距： 个体内部和个体之间的冷漠症状。此外，目前还不清楚护理人员的沟通如何影响 冷漠因此，本研究将探讨照顾者沟通对冷漠的影响。这是一个次要 使用来自NIH资助的已完成临床试验的现有视频数据进行分析。数据集包括视频 观察46名居民在12个国家卫生机构的居民互动。录像是在 在5-9个月的多个时间点进行常规护理活动。本研究旨在研究 冷漠症状的程度和持续时间，并检查并发和顺序关系 护理者沟通和冷漠症状之间的关系。首先，我们将测试冷漠模式的变化， 居民，在同一居民之间的互动，并在每个互动。接下来，我们将分析四个 照顾者沟通品质的方面：1）沟通主题，2）情感基调，3）以人为本 4）以人为本的非语言交际。我们期望以人为本 沟通方法将与较低水平的冷漠症状相关。这是第一项研究 研究照顾者沟通对冷漠的影响。调查结果将有助于确定改进的方法 护理人员沟通，可用于制定干预措施，以减少冷漠，改善居民 健康结果、生活质量和降低NH ADRD居民的死亡率。这项研究将有助于促进 ADRD的护理质量和效率，并实现2017年国家计划的主要目标 老年痴呆症