Resident-to-Resident Elder Mistreatment Intervention for Dementia Care in Assisted Living

辅助生活中痴呆症护理中居民对居民虐待老人的干预措施

• 批准号: 9419545
• 负责人: MARK STEVEN LACHS
• 金额: $ 49.74万
• 依托单位: HEBREW HOME FOR THE AGED AT RIVERDALE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9419545
• 关键词: Accidents; Activities of Daily Living; Address; Affective; Aggressive behavior; Aging; Alzheimer' s Disease; Area; Assisted Living Facilities; Awareness; Behavior; Behavior Disorders; Behavioral; Caring; Characteristics; Cluster randomized trial; Comorbidity; Data; Data Reporting; Dementia; Discipline of Nursing; Disease; Distress; Doctor of Philosophy; Educational Intervention; Elder Abuse; Elderly; Experimental Designs; Focus Groups; Frequencies; Geriatrics; Gerontology; Goals; Impaired cognition; Individual; Injury; Intervention; Interview; Knowledge; Living Arrangement; Long-Term Care; Measurement; Measures; Mediating; Methodology; Minority; Movement; Nurses; Nursing Homes; Outcome; Persons; Positioning Attribute; Prevalence Study; Problem behavior; Process; Professional Role; Public Health; Publishing; Quality of Care; Quality of life; Randomized; Reporting; Research; Risk; Role; Safety; Services; Source; Support System; Testing; Time; Training; Treatment Effectiveness; Vulnerable Populations; case finding; community setting; compare effectiveness; comparison group; dementia care; falls; group intervention; improved; informant; innovation; intervention program; multidisciplinary; pragmatic trial; prevent; prospective; psychologic; psychological distress; rapid growth; residence; response; social; staff intervention; statistics; treatment as usual; trend

This application proposes a cluster randomized trial to evaluate an innovative staff intervention targeting resident-to-resident elder mistreatment (R-REM) in 6 intervention and 6 control assisted living residences (ALRs). Data will be collected at baseline, 6- and 12-months. We define R-REM as negative and aggressive physical, sexual, or verbal interactions between residents, that in a community setting would likely be construed as unwelcome and have high potential to cause physical and/or psychological distress. R-REM is a serious behavioral problem that has a negative impact on the quality-of-life and physical well-being of residents with and without Alzheimer’s disease and related dementias living in congregate settings. The applicant team is uniquely positioned to conduct this project because of its expertise, multidisciplinary composition, and its previous successful collaborative efforts. Aim 1 (A1). Enhance staff knowledge of R-REM Aim 2 (A2). Enhance staff recognition, reporting and care planning related to R-REM Aim 3 (A3). Evaluate the impact of the staff intervention on resident falls, accidents and injuries and on quality of life using a prospective experimental design that derives information from five sources: (1) Resident interviews (2) Staff informants (3) Observational data (4) Chart and (5) Incident/accident report data. Primary Hypothesis: The frequency of falls, accidents and injuries will decrease in the intervention group, relative to the comparison group after implementation of the training intervention. Secondary Hypotheses: 1. Resident quality-of-life as measured by affective state will improve in the intervention group, relative to the comparison group after implementation of the training intervention. 2. Resident behavior problems will decline in the intervention group, relative to the comparison group after implementation of the training intervention. Resident behaviors will mediate the relationship between the intervention and the falls/accidents/injuries outcome. R-REM has been identified as an important problem in long-term care settings, and our earlier studies identified significant behavioral problems in these settings. However, to our knowledge no interventions targeted at staff have been proposed or tested. The proposed trial is thus timely and innovative. The results are likely applicable to the over 1.2 million residents of AL facilities. With the expected rapid growth in ALRs, and the growing trend to include residents with significant care needs and dementia-related behaviors, the project will serve an important role in improving the quality of care provided by staff.

该应用程序提出了一项整群随机试验，以评估创新的员工干预目标 居民对居民虐待老年人(R-REM)在6个干预性和6个对照的辅助性居住社区中的研究 (ALRS)。数据将在基线、6个月和12个月时收集。我们将R-REM定义为消极的和攻击性的 居民之间的身体、性或言语互动，在社区环境中很可能是 被认为是不受欢迎的，很有可能造成身体和/或心理上的痛苦。R-REM是一种 对居民的生活质量和身体健康有负面影响的严重行为问题 无论有没有阿尔茨海默病和相关的痴呆症，都生活在聚集的环境中。申请者团队 由于其专业知识、多学科的组成以及其 之前成功的合作努力。 目标1(A1)。提高员工对R-REM的认识 目标2(A2)。加强与R-REM相关的员工认可、报告和护理规划 目标3(A3)。评估工作人员干预对居民跌倒、事故和伤害以及质量的影响 使用前瞻性实验设计，从五个来源获得信息：(1)居民 访谈(2)工作人员告密者(3)观察数据(4)图表和(5)事件/事故报告数据。 基本假设：在干预中，跌倒、事故和受伤的频率将会下降 组内，相对对照组实施后的训练干预。 第二假设：1.以情感状态衡量的居民生活质量将在 干预组，相对对照组实施后的训练干预。 2.与对照组相比，干预组居民的行为问题有所下降 实施后的培训干预。居民行为将调解这一关系 在干预和跌倒/事故/伤害结果之间。 R-REM已被确定为长期护理环境中的一个重要问题，我们早期的研究 在这些环境中发现了严重的行为问题。然而，据我们所知，没有干预 已经提出或测试了针对工作人员的方案。因此，拟议的审判是及时和创新的。结果是 可能适用于AL设施的120多万居民。随着预期的ALR的快速增长， 而且越来越多的趋势是包括有重大护理需求和痴呆症相关行为的居民， 该项目将在提高工作人员提供的护理质量方面发挥重要作用。