Aggression Prevention Training for Caregivers of Persons with Dementia

痴呆症患者照顾者的攻击预防培训

• 批准号: 9091304
• 负责人: Mark E. Kunik
• 金额: $ 59.77万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-03 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9091304
• 关键词: Active Learning; Address; Aggressive behavior; Antipsychotic Agents; Behavioral; Biological Factors; Books; Boxing; Caregiver Burden; Caregivers; Caring; Communication; Communities; Cox Proportional Hazards Models; Data Analyses; Dementia; Dementia caregivers; Development; Education; Educational Materials; Exhibits; Family Caregiver; Frequencies; Funding; Health; Home environment; Incidence; Individual; Injury; Institutionalization; Intervention; Lead; Longitudinal Studies; Measures; Mental Depression; Modeling; Morbidity - disease rate; Multimedia; Nursing Homes; Outcome; Pain; Patients; Persons; Pharmaceutical Preparations; Prevalence; Prevention strategy; Preventive; Primary Health Care; Problem behavior; Provider; Psychological Factors; Randomized; Randomized Controlled Trials; Recruitment Activity; Risk; Risk Factors; Role playing therapy; Social support; Telephone; aggression prevention; base; biopsychosocial; caregiver depression; caregiver education; caregiver interventions; caregiving; depressive symptoms; design; evidence base; improved; inferential statistics; innovation; loved ones; meetings; mortality; prevent; psychologic; skills; skills training; statistics; symptom management; tool

DESCRIPTION (provided by applicant): Caregivers of persons with dementia (PWD) are often responsible for their loved one's daily care coordination and provision. Eighty percent of PWD have behavioral or psychological disturbances, including 40% that are aggressive behaviors. Aggressive behaviors are perhaps the most problematic disturbances because they lead to increased institutionalization, injuries, and use of antipsychotic medications; yet few interventions for aggressive behavior are available. Innovative preventive approaches are urgently needed to replace the use of tranquilizing medications because of their associated increased mortality and morbidity in PWD. The prevalence of pain in PWD is about 60%, and it is a strong predictor of aggression. The biopsychosocial model of pain posits that pain is bidirectionally related to psychological factors (ie, depression) and social support factors (i.e., quality of caregiver/PWD relationship) in addition to biological factors. Thus, depression and quality of the caregiver/PWD relationship can be seen as pain-related features. Caregivers are ideally suited to help address pain, depression, and the caregiver/PWD relationship, thus preventing the development of aggression; but they need tools to assist them in identifying and managing these symptoms. The objectives of this proposal are to assess whether this caregiver intervention, Aggression Prevention Training for Caregivers of Individuals with Dementia (APT), 1) decreases incidence of aggression, 2) decreases aggression-related outcomes (nursing-home placement, caregiver burden, positive aspects of caregiving, and behavior problems), and 3) decreases pain and pain-related features (depression, caregiver/PWD relationship difficulties). This 5-year randomized controlled trial based on the Unmet Needs Model will focus on preventing aggression in PWD with pain and pain-related features by providing the caregiver with targeted education and skill training. PWD and their caregivers will be randomized to APT or to an enhanced usual primary care condition (EU-PC). APT will use active learning tools, including didactics, role- playing, and multimedia (eg, books and DVDs) to educate and provide skill training for the caregiver. The 6-8 modules in the intervention will include 4 core modules that address 4 main aggression risk factors: a) recognizing pain, b) treating pain, c) increasing pleasant activities, and d) improving patient-caregiver communication. Caregivers can select 2 to 3 additional elective sessions; elective selection is guided by the needs of the dyad to further enhance skills related to these core topics. EU-PC provides the patient and caregiver educational materials on pain, notifies the primary care provider of the PWD's level of pain and depression, and provides 8 weekly supportive telephone calls to caregivers. PWD and caregiver outcomes will be collected at baseline, 3, 6 and 12 months. Data analysis will include both univariate descriptive statistics and inferential statistics, including regression models, repeated measure modeling and Cox proportional hazards models.

描述（由申请人提供）：痴呆症患者（PWD）的护理人员通常负责他们所爱的人的日常护理协调和提供。80%的PWD有行为或心理障碍，其中40%是攻击性行为。攻击性行为可能是最有问题的障碍，因为它们导致机构化，伤害和抗精神病药物的使用增加;但很少有针对攻击性行为的干预措施。迫切需要创新的预防方法来取代镇静药物的使用，因为它们与PWD的死亡率和发病率增加有关。PWD中疼痛的患病率约为60%，它是攻击性的强有力预测因素。疼痛的生物心理社会模型假定疼痛与心理因素（即抑郁）和社会支持因素（即， 护理者/残疾人关系的质量）以及生物因素。因此，抑郁和护理人员/PWD关系的质量可以被视为疼痛相关特征。护理人员非常适合帮助解决疼痛，抑郁和护理人员/PWD关系，从而防止侵略的发展;但他们需要工具来帮助他们识别和管理这些症状。 本提案的目的是评估这种护理人员干预，即针对痴呆患者护理人员的攻击预防培训（APT），是否1）降低攻击发生率，2）降低攻击相关结局（养老院安置、护理人员负担、治疗的积极方面和行为问题），3）减少疼痛和疼痛相关特征（抑郁、护理人员/PWD关系困难）。这项基于未满足需求模型的5年随机对照试验将通过为护理人员提供有针对性的教育和技能培训，重点关注预防有疼痛和疼痛相关特征的PWD患者的攻击行为。PWD及其护理人员将被随机分配至APT或增强型常规初级护理条件（EU-PC）。APT将使用主动学习工具，包括教学法、角色扮演和多媒体（如书籍和DVD），为护理人员提供教育和技能培训。干预中的6-8个模块将包括4个核心模块，解决4个主要的攻击风险因素：a）识别疼痛，B）治疗疼痛，c）增加愉快的活动，d）改善患者与护理人员的沟通。护理人员可以选择2至3个额外的选修课程;选修课程的选择是由二元组的需求指导，以进一步提高与这些核心主题相关的技能。EU-PC为患者和护理人员提供有关疼痛的教育材料，通知初级保健提供者PWD的疼痛和抑郁程度，并每周为护理人员提供8次支持性电话。将在基线、3、6和12个月时收集PWD和护理人员结局。数据分析将包括单变量描述性统计量和 推理统计学，包括回归模型、重复测量建模和考克斯比例风险模型。