A non-pharmacological intervention for patients with Alzheimer s disease and family caregivers

针对阿尔茨海默病患者和家庭护理人员的非药物干预

• 批准号: 9925045
• 负责人: SARA J CZAJA
• 金额: $ 45.62万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9925045
• 关键词: Address; Adult; Affect; African American; Alzheimer' s Disease; Alzheimer' s disease care; Alzheimer' s disease caregiver; Alzheimer' s disease patient; Area; Behavioral Symptoms; Caregivers; Caring; Caucasians; Cognitive; Communities; Dementia; Dietary Intervention; Distress; Educational Intervention; Effectiveness of Interventions; Emotional; Exercise; Family; Family Caregiver; Family member; Future; Goals; Health; Hispanics; Impairment; Individual; Intervention; Investigation; Maintenance; Measures; Meta-Analysis; Modeling; Outcome; Patients; Performance; Persons; Population Heterogeneity; Prevalence; Psyche structure; Public Health; Quality of life; Randomized; Resources; Risk; Role; Savings; Services; Site; Societies; Stress; Tablet Computer; Technology; Time; Training; Training Technics; Work; aged; base; behavioral response; care recipients; caregiver interventions; caregiving; cognitive training; cost; cost effectiveness; cost estimate; design; disparity reduction; dosage; effectiveness trial; efficacy testing; ethnic difference; evidence base; experience; flexibility; functional status; improved; improved outcome; indexing; innovation; innovative technologies; intervention cost; intervention program; loved ones; member; multi-component intervention; novel; patient population; practical application; programs; response; therapy development

Abstract An increasing number of adults in the U.S. provide care to someone aged 50+ years with Alzheimer's disease (AD). Alzheimer's disease is a devastating illness affecting patients, family members and society. There is a need to identify interventions that decrease the cognitive and functional manifestations of the condition in the patient and the negative consequences experienced by family caregivers. Evidence suggests that non- pharmacological intervention approaches can be beneficial to both caregivers and AD patients. However, most intervention programs have exclusively focused on the caregiver or the patient, despite emerging evidence of a reciprocal interaction between the dyad. Also, most caregiver programs have targeted caregivers of patients in the moderate to severe stages of the illness. In addition, cognitive interventions for individuals with AD have been dependent on facility based training approaches, which limit feasibility and cost effectiveness. The proposed study will develop and test the efficacy and feasibility of a dyadic-based intervention program (DT), delivered through state-of-the art computer tablet technology. A novel feature of the investigation is its focus on both the caregiver and the recipient of care (person with AD) and the integration of an evidenced- based caregiver intervention and evidenced-based cognitive/functional training for the care recipient. The program will be tailored for the caregiver and emphasize issues important to caregivers, not only in the earlier stages of caregiving, but will also target issues across the caregiving trajectory to help prepare the caregiver for changes in their role. The cognitive/functional training will be targeted to the needs of the care recipient. The DT intervention will be 6 months in duration and compared to a control condition (CC) that combines standard a nutrition intervention for the caregiver and mental stimulation exercises for care recipient. Two hundred and forty Hispanic, African American and White/Caucasian dyads will be randomized to the DT intervention or CC condition. Measures at baseline and the 6 and 12-month follow-ups will include indices of care recipient cognitive and functional status, and caregiver outcomes such as; quality of life, distress, and caregiving efficacy. Information will also be gathered on ethnic differences in response to the intervention and estimates of cost effectiveness of the intervention. The DT intervention is highly innovative given the focus on a dyadic approach, the use of state-of-the-art technology for intervention delivery, a community-based and stage-model approach to intervention development, the inclusion of the caregiver as a therapy extender and cultural tailoring of the program.

摘要 越来越多的美国成年人为50岁以上的阿尔茨海默病患者提供护理 （AD）。阿尔茨海默病是一种影响患者、家庭成员和社会的毁灭性疾病。有一个 需要确定干预措施，减少认知和功能表现的条件， 病人和家庭照顾者所经历的负面后果。有证据表明，非 药物干预方法对护理人员和AD患者都是有益的。但大多数 干预计划只关注照顾者或病人，尽管有证据表明， 二分体之间的相互作用。此外，大多数护理人员计划都以患者的护理人员为目标 在疾病的中度到重度阶段。此外，对AD患者的认知干预， 一直依赖于基于设施的培训方法，这限制了可行性和成本效益。 这项拟议的研究将开发和测试的有效性和可行性的二元为基础的干预计划 (DT)，通过最先进的平板电脑技术提供。调查的一个新特点是， 关注护理者和护理接受者（AD患者），并整合证据- 基于护理人员的干预和基于证据的认知/功能培训的照顾接受者。的 计划将为照顾者量身定制，并强调对照顾者重要的问题，不仅在早期 阶段，但也将针对整个护理轨迹的问题，以帮助护理人员做好准备 他们角色的改变。认知/功能培训将针对护理接受者的需求。 DT干预将持续6个月，并与对照条件（CC）进行比较， 为照顾者提供标准的营养干预，为照顾者提供心理刺激练习。两 将140例西班牙裔、非裔美国人和白色/高加索人配对患者随机分配至DT组 干预或CC条件。基线以及6个月和12个月随访时的测量将包括以下指数： 护理接受者的认知和功能状态，以及护理者的结果，如：生活质量、痛苦和 有效性。还将收集关于族裔差异的信息，以应对干预措施， 评估干预措施的成本效益。DT干预是高度创新的，因为重点是 采用双元方法，使用最先进的技术进行干预，以社区为基础， 干预开发的阶段模型方法，将护理人员作为治疗扩展者， 节目的文化特色。