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A Problem Solving Intervention for Post-ICU Cognitive Impairment in Older Adults

针对老年人 ICU 后认知障碍的问题解决干预措施

基本信息

批准号：
9914194
负责人：
Judith Ann Tate
金额：
$ 15.6万
依托单位：
OHIO STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-04-15 至 2023-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9914194
关键词：
Academic Medical Centers Acute Address Adherence Adult Affective Age Alzheimer&apos s Disease Alzheimer&apos s disease related dementia Anxiety Behavior Blinded Brain Cardiovascular system Cellular Phone Chronic Disease Cognitive Control Groups Critical Illness Data Data Collection Decision Making Delirium Dementia Development Disease Elderly Electrolytes Enrollment Environmental Risk Factor Goals Health Home environment Hospitals Impaired cognition Impairment Infrastructure Intensive Care Units Intervention Linear Regressions Liquid substance Lung Manuals Manuscripts Mechanics Mediating Medical Mental Depression Modeling National Institute on Aging Neurobehavioral Manifestations Online Systems Outcome Participant Patients Personal Satisfaction Persons Pilot Projects Prevalence Problem Solving Process Protocols documentation Quality of life Randomized Randomized Controlled Trials Rehabilitation therapy Research Resources Risk Sample Size Science Self Efficacy Self Management Severities Social support Structure Survivors Syndrome Technology Telephone Testing Training Trauma Traumatic Brain Injury base burden of illness cognitive change cognitive function cognitive rehabilitation comorbidity dementia risk design disability effective intervention effectiveness testing efficacy study experience follow-up functional decline group intervention health care service utilization health related quality of life intervention effect operation physical symptom post intervention programs psychological symptom recruit trial comparing

项目摘要

PROJECT SUMMARY At 1-year post-ICU discharge, two-thirds of ICU survivors experience cognitive dysfunction at a severity comparable to that of patients with mild Alzheimer's disease or moderate traumatic brain injury, regardless of age or pre-morbid chronic illness burden. Despite the prevalence, significance and persistence of cognitive impairment following critical illness, few interventions have been tested that help ICU survivors overcome these cognitive changes. The purpose of this pilot study is to evaluate the feasibility, acceptability and efficacy of a problem solving intervention, Post Intensive Care Unit Problem Solving (PIC-UPS) in the home setting for older adult ICU survivors suffering from post-ICU cognitive impairment. This study will employ a small-scale two-group randomized controlled trial (RCT) comparing the effect of a ten session intervention with a Control Group (CG) for older adult ICU survivors who have cognitive impairment at hospital discharge on cognitive function, chronic illness self-management, affective well-being (anxiety, depression), health care utilization and health related quality of life (HR-QoL). The components of PIC-UPS include (1) in-person, in-home strategy training designed to overcome cognitive problems by employing comprehensive structured problem- solving strategies delivered by trained interventionists and (2) concomitant use of smartphone technology specifically designed to remind and reinforce in-person training. The study will be conducted in the adult medical ICUs at a large Midwestern academic medical center with older adult participants (n=80) recruited prior to home discharge and randomized to either intervention or control group. Baseline data collection will occur at enrollment. The first session of PIC-UPS will be delivered after enrollment to those participants randomized to the intervention group n the hospital setting. Weekly intervention sessions (9) will be conducted by a trained interventionist and supplemented by telephone reminders to complete daily homework. Follow- up data collection will be conducted in the home for all participants (intervention and control group) by a blinded data collector three months post-enrollment. This study will provide data on processes critical to further hypothesis development and to the successful development of a large RCT to test the effectiveness of PIC-UPS on cognitive function, chronic illness self- management, affective well-being (anxiety, depression), health care utilization and HR-QoL in older adult ICU survivors who suffer cognitive impairment at hospital discharge. In addition, our pilot will provide infrastructure for a larger trial (e.g., manual of operations, web-based data collection form), a manuscript describing the pilot study findings, and an R01 application to NIA.

项目摘要在ICU出院后1年，三分之二的ICU幸存者经历认知功能障碍，严重程度与轻度阿尔茨海默病或中度创伤性痴呆患者相当脑损伤，无论年龄或发病前的慢性疾病负担。尽管流行，严重疾病后认知障碍的显著性和持续性，很少干预帮助ICU幸存者克服这些认知变化。的目的本试点研究旨在评估一个问题解决方案的可行性、可接受性和有效性。干预，重症监护病房后问题解决（PIC-UPS）在家庭环境中，患有ICU后认知障碍的老年ICU幸存者。本研究将采用一项小规模两组随机对照试验（RCT），比较10次治疗的效果对有认知障碍的老年ICU幸存者进行对照组（CG）干预出院时认知功能、慢性病自我管理情感幸福感（焦虑、抑郁）、卫生保健利用和健康相关生活质量（HR-QoL）。PIC-UPS的组成部分包括（1）面对面的家庭战略培训旨在通过采用全面的结构化问题来克服认知问题- 由训练有素的干预人员提供的解决策略，以及（2）同时使用智能手机专门设计用于提醒和加强面对面培训的技术。本研究将在中西部一家大型学术医疗中心的成人医疗ICU中进行，成年受试者（n=80）在出院前招募，并随机接受任一干预或对照组。基线数据收集将在入组时进行。PIC-UPS第一届会议将在入组后分发给随机分配至干预组n的受试者医院设置。每周干预会议（9）将由受过培训的此外，还采取干预措施，并辅以电话提醒，以完成每日作业。关注- 所有参与者的数据收集将在家中进行（干预和控制组）由盲态数据收集器在入组后三个月进行。这项研究将提供数据，对进一步发展假说和成功发展一个一项大型随机对照试验，旨在测试PIC-UPS对认知功能、慢性疾病自我治疗、管理，情感幸福感（焦虑，抑郁），医疗保健利用和HR-QoL 老年ICU幸存者在出院时患有认知障碍。另外我们试点将为更大的试验提供基础设施（例如，业务手册，网上数据收集表），描述初步研究结果的手稿，以及向NIA提交的R 01申请。