LEAF 2.0: Randomized trial of a technology-based positive emotion intervention for informal caregivers of individuals with Alzheimer's disease

项目摘要 阿尔茨海默氏病（AD）和其他痴呆症的患病率正在稳步攀升，预计将影响 到2050年将达到1600万美国人2016年，59%的痴呆症护理人员报告说， 情绪和身体压力的水平，以及痴呆症的慢性压力对 大量文献记载了护理人员对发展一系列身心健康问题的影响。 此外，护理负担对护理质量和生活质量产生有害影响 收件人。对痴呆症照顾者的干预主要集中在减少负面情绪， 负担然而，在过去的几十年里，人们已经清楚地认识到，积极的情绪是独特的相关 更好的心理和身体健康，独立于负面情绪的影响， 一种专门针对积极情绪的干预措施有望改善照顾者的幸福感， 以及最终对AD患者的护理质量。我们最近的随机试验， 情绪技能干预，由受过培训的促进者通过网络在N = 170人的家庭照顾者中提供 痴呆症患者的护理人员的心理健康得到了显着改善。不过，主持人- 所提供的干预措施成本高昂，难以大规模忠实地实施。因此，我们建议 采取下一步行动，通过进行三臂 一项基于技术的随机对照试验（N = 500）， 阿尔茨海默病（AD）被随机分为1）通过网络远程促进的LEAF干预（N = 200）， 2)LEAF干预自我引导在线（N = 200），或3）情绪报告控制（N = 100），其将 然后在大约6个月后交叉到干预，一半到易化臂，一半到 我们的具体目标是：1）比较基于网络的自我指导和促进者的效果- 引导LEAF积极情绪干预对AD照顾者情绪报告控制状况的影响 存在（积极情绪，抑郁，焦虑和感知压力）。2)探讨LEAF对植物生长发育的影响 负担，自我效能，积极的方面，护理质量和AD患者的生活质量 并评估对这些结果的影响是否由积极情绪或其他方面的改善介导。 3）测试护理人员的年龄或性别，或患者痴呆的严重程度 减轻干预的影响。这项建议是响应国家护理研究所 研究和国家老龄问题研究所PAR-15-348“非正式和正式照顾老年人的研究” 阿尔茨海默氏症”，因为我们建议测试一种基于技术的干预措施，以减轻照顾者的负担 如果证明是有效的，可以广泛传播，并最终对 AD护理人员所经历的压力和阿尔茨海默病患者的福祉。

Project Summary The prevalence of Alzheimer's Disease (AD) and other dementias is steadily climbing and predicted to affect as many as 16 million Americans by 2050. In 2016, 59% of dementia caregivers reported experiencing high levels of emotional and physical stress, and the risk that the chronic stress of dementia caregiving places on caregivers for developing a range of physical and mental health issues is extensively documented. Furthermore, caregiving burden has a deleterious impact on caregiving quality and quality of life in the care recipient. Interventions for dementia caregivers have primarily focused on reducing negative emotions and burden. However, over the past few decades, it has become clear that positive emotions are uniquely related to better psychological and physical well-being, independent of the effects of negative emotion suggesting that an intervention that specifically targets positive emotion holds promise for improving caregiver well-being and, ultimately, quality of care for the individual living with AD. Our recent randomized trial of the positive emotion skills intervention, delivered by trained facilitators via the web in N = 170 family caregivers of people with dementia resulted in significant improvements in caregiver psychological well being. However, facilitator- delivered interventions are costly and difficult to implement with fidelity on a large scale. Thus, we propose to take the next step toward widespread implementation of the LEAF intervention by conducting a 3-arm technology-based randomized controlled trial (N = 500) in which family caregivers of patients with Alzheimer's Disease (AD) are randomized to 1) the LEAF intervention facilitated remotely via web (N = 200), 2) the LEAF intervention self-guided online (N = 200), or 3) an emotion reporting control (N = 100) which will then cross over to the intervention after approximately 6 months, half to the facilitated arm and half to the self-guided arm. Our Specific Aims are to: 1) Compare the effect of web-based self-guided and facilitator- guided LEAF positive emotion intervention to an emotion reporting control condition on AD caregiver well- being (positive emotion, depression, anxiety, and perceived stress). 2) Explore effects of LEAF on caregiving burden, caregiving self efficacy, positive aspects of caregiving, quality of care, and AD patient quality of life and assess whether effects on these outcomes are mediated by improvements in positive emotion or other aspects of caregiver well being, and 3) Test whether caregiver age or gender, or patient dementia severity moderate the effects of the intervention. This proposal is responsive to the National Institute of Nursing Research and National Institute on Aging PAR-15-348 “Research on Informal and Formal Caregiving for Alzheimer's Disease” in that we propose to test a technology-based intervention to reduce caregiver burden that, if demonstrated to be effective, can be widely disseminated and ultimately have a significant impact on the stress experienced by AD caregivers and the well-being of people living with Alzheimer's disease.