Promoting Reengagement in Daily Meaningful Activity Intervention for Adults with Mild Cognitive Impairment and Their Caregivers

促进轻度认知障碍成年人及其照顾者重新参与日常有意义的活动干预

• 批准号: 10181084
• 负责人: Yueh-Feng Yvonne Lu
• 金额: $ 54.03万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-05 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10181084
• 关键词: Active Listening; Activities of Daily Living; Address; Adult; Aging; Agreement; American; Anxiety; Assisted Living Facilities; Behavior Therapy; Caregiver Burden; Caregivers; Caring; Cognitive; Communication; Communities; Control Groups; Data; Dementia; Effectiveness of Interventions; Elderly; Exercise; Family; Family Caregiver; Fostering; Frustration; Future; Goals; Health; Health Promotion; Impairment; Intervention; Intervention Studies; Judgment; Knowledge; Learning; Life; Medication Management; Memory; Mental Depression; Modeling; Nurses; Outcome; Participant; Patient Care; Patient-Focused Outcomes; Patients; Perception; Performance; Persons; Pilot Projects; Problem Solving; Questionnaires; Randomized; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Reporting; Risk; Sampling; Self Efficacy; Self Management; Socialization; Support Groups; Symptoms; Testing; Time; Translations; Work; attentional control; base; cognitive training; depressive symptoms; design; efficacy evaluation; executive function; experience; improved; interest; mild cognitive impairment; multi-component intervention; nutrition; patient engagement; patient home care; prospective; satisfaction; skills; social; symptomatic improvement

PROJECT ABSTRACT This study examines efficacy of a theoretically-based, positive health focused, tailored, nurse-delivered, family- centered intervention: “Daily Engagement in Meaningful Activity” (DEMA). DEMA is designed for older persons with mild cognitive impairment (MCI) and family caregivers. Nearly 20% of Americans over 65 have MCI. Patients with MCI (patients) experience reduced life satisfaction due to patients’ increasing lack of confidence and diminished ability to perform meaningful and/or important activities, leading to diminished meaningful activity engagement, depressive symptoms, and anxiety. Caregivers lack confidence to manage their own and their patient’s daily challenges, leading to high caregiver burden, depressive symptoms, and anxiety. Patients and caregivers (dyads) report diminished satisfaction with their communication and relationship due to disagreements regarding the patient’s functional ability. Patient/caregiver behavioral interventions are more successful when they occur before progression to dementia. Previous cognitive intervention studies used limited, single domain foci (e.g., cognitive training, exercise, or nutrition) that may not be meaningful enough to sustain patient engagement long enough to improve life satisfaction. Emerging evidence, including our pilot studies, suggests regular engagement in self-identified meaningful activities can improve life satisfaction and depression and reduces risk of developing dementia. The purpose of this randomized controlled trial is to determine efficacy of DEMA compared to an information support (IS) attention control group. DEMA: 1) fosters active listening to increase dyad agreement in perceptions of patient functional ability; 2) helps dyads enhance engagement in and satisfaction with self-identified meaningful activities through problem solving to assess, prioritize, and achieve identified meaningful activity goals; 3) builds on patient’s existing interests and skills; and 4) provides information and didactic support to address priority concerns and dyad adjustment to functional changes and plan for the future. Specific aims are: 1) test DEMA’s efficacy for improve patient/ caregiver life satisfaction; 2) test DEMA’s efficacy to improve activity performance, depressive symptoms and anxiety in patients and burden, depressive symptoms, anxiety in caregivers; and, 3) explore a sub-sample of patients with higher depressive symptoms for improvement in health outcomes over time, compared to non- depressed patients. Eligible patient/caregiver dyads (n = 200) will be randomized to a 7-session DEMA or IS intervention, with data collected at baseline and 3 times over 9 months. Mixed model effects will be analyzed. If efficacious, DEMA will provide high impact on the care of patients and caregivers by maintaining their engagement in meaningful activities to improve patient and caregiver life satisfaction, depressive symptoms, anxiety, relationship satisfaction, activity performance, and caregiver burden. It will also provide information regarding the extent to which patients who have more depression may benefit and empirical evidence of the effectiveness of an intervention for translation into practice.

项目摘要 这项研究检验了以理论为基础、以积极健康为中心、量身定制、由护士提供、家庭护理的功效。 集中干预：“每日参与有意义的活动”（DEMA）。 DEMA 专为老年人设计 患有轻度认知障碍（MCI）和家庭照顾者。 65 岁以上的美国人中有近 20% 患有 MCI。 由于患者越来越缺乏信心，MCI 患者的生活满意度降低 以及执行有意义和/或重要活动的能力下降，导致有意义的活动减少 活动投入、抑郁症状和焦虑。护理人员缺乏管理自己和护理人员的信心 患者每天面临的挑战，导致护理人员的沉重负担、抑郁症状和焦虑。患者 和照顾者（二人）报告称，由于以下原因，他们对沟通和关系的满意度下降 关于患者功能能力的分歧。患者/护理人员的行为干预更多 当它们发生在进展为痴呆之前时是成功的。之前使用的认知干预研究 有限的、单一领域的焦点（例如认知训练、锻炼或营养）可能没有足够的意义 保持患者足够长的参与度以提高生活满意度。新出现的证据，包括我们的试点 研究表明，定期参与自我认定的有意义的活动可以提高生活满意度 抑郁症并降低患痴呆症的风险。这项随机对照试验的目的是 确定 DEMA 与信息支持 (IS) 注意力对照组相比的功效。 DEMA：1）培育 积极倾听，以增加对患者功能能力认知的二元一致性； 2）帮助二人增强 通过解决问题来评估对自我认定的有意义的活动的参与和满意度， 优先考虑并实现已确定的有意义的活动目标； 3) 以患者现有的兴趣和技能为基础； 4) 提供信息和教学支持，以解决优先问题和对 功能变化和未来计划。具体目标是：1) 测试 DEMA 对改善患者/ 照顾者生活满意度； 2）测试DEMA改善活动表现、抑郁症状和 患者的焦虑和负担、抑郁症状、护理人员的焦虑；以及，3）探索子样本 与非抑郁症状患者相比，随着时间的推移，患者的健康结果会得到改善 抑郁症患者。符合条件的患者/护理人员二人组 (n = 200) 将被随机分配至 7 次 DEMA 或 IS 干预，在基线和 9 个月内收集 3 次数据。将分析混合模型的效果。 如果有效，DEMA 将通过维持患者和护理人员的护理对他们的护理产生重大影响 参与有意义的活动，以提高患者和护理人员的生活满意度、抑郁症状、 焦虑、关系满意度、活动表现和照顾者负担。它还将提供信息 关于患有更多抑郁症的患者可能受益的程度以及相关的经验证据 干预措施转化为实践的有效性。