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A home-based, culturally and language specific intervention for dementia family caregivers: stress reduction and education with wearable technology for health

针对痴呆症家庭护理人员的基于家庭、文化和语言的特定干预措施：利用可穿戴技术减轻压力并进行健康教育

基本信息

批准号：
10642877
负责人：
Jung-Ah Lee
金额：
$ 70.38万
依托单位：
UNIVERSITY OF CALIFORNIA-IRVINE
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-15 至 2025-05-31
项目状态：
未结题

项目摘要

ABSTRACT Over 5.8 million Americans are living with Alzheimer's dementia, a disease with no effective treatment and no cure. Two-thirds of the caregivers for persons with dementia (PWD) are women (most often family) and a third are themselves over 65. Dementia takes a significant toll on caregivers, often resulting in chronic stress, depression, sleep disorders, poor health related quality of life (HRQOL), and early mortality due 24/7 care responsibility for PWD. Research has shown significant barriers to dementia care for underserved populations, including Latinos and Asian minorities. Underserved family caregivers for PWD tend to underutilize public health services available, and do not seek treatment until the situation is unmanageable with current resources reporting barriers that included language, time, and finances. Monitoring the caregiver's health and wellbeing is important as well as their maintaining a positive interaction with the PWD. Thus, there is a need for an innovative and feasible intervention to improve underserved caregiver's mental and physical health. Little research is reported for dementia caregiver interventions in underserved minorities and one given at home by community health workers (CHWs). The proposed intervention meets the needs of these family caregivers in developing a positive relationship with the PWD by educating caregivers to better understand the PWD's behaviors. Another component of the intervention is stress reduction techniques, including mindful deep breathing and compassionate support/listening to reduce depression and improve family relationships making the caregiving less burdensome. By monitoring the physiological responses of stress (i.e. heart rate variability), sleep and activity, we can objectively measure changes as a result of the intervention. Using Wearable Internet of Things (WIoT) technology, a combination of Watch/ring-Smartphone-Cloud, has proven to be a significant method of monitoring behavioral and physiological measures providing evidence of change over time and uniquely associated with this intervention. Our preliminary data show that the intervention with WIoT brought to the caregiver by CHW home visitors was acceptable to ethnic caregivers (Latino, Vietnamese, and Korean) and effective in reducing caregiver stress and burden over the short term. With the addition of non-Hispanic Whites, the proposed caregiver-centered, culturally and language appropriate, CHW home-visit-based 3-month intervention has 3 significant parts:1) stress reduction by mindful breathing and compassionate support/ listening to improve caregiver's health and well-being; 2) education on caregiving skills to improve responses to the PWD and in turn their behaviors; 3) WIoT physiological and behavioral monitoring. This 6-month randomized controlled trial will compare outcomes (burden, depression, HRQOL, PWD behaviors, caregiving self-efficacy) between the intervention, attention control with use of the WIoT only, and usual care groups at baseline, 3 months, and 6 months. This intervention using the CHW-model and WIOT technology has the potential to lessen health disparities in dementia caregiving in ethnic and underserved family caregivers.

摘要超过580万美国人患有阿尔茨海默氏痴呆症，这种疾病没有有效的治疗方法，疗方三分之二的痴呆症患者（PWD）护理人员是女性（通常是家庭），三分之一是女性。他们自己超过65岁。痴呆症会对照顾者造成严重影响，通常会导致慢性压力，抑郁症、睡眠障碍、健康相关生活质量（HRQOL）差以及由于24/7护理导致的早期死亡 PWD的责任。研究表明，对服务不足的人群进行痴呆症护理存在重大障碍，包括拉丁裔和亚裔少数民族。服务不足的残疾人家庭照顾者往往没有充分利用公共卫生服务，直到目前的资源无法控制时才寻求治疗报告障碍，包括语言，时间和资金。监测照顾者的健康和福祉是重要的是，他们与残疾人保持积极的互动。因此，需要一种创新和可行的干预措施，以改善得不到充分服务的照顾者的身心健康。小据报道，研究痴呆症护理干预服务不足的少数民族和一个在家里给予社区卫生工作者（CHW）。拟议的干预措施满足了这些家庭照顾者的需要，通过教育护理人员更好地了解残疾人的行为。干预的另一个组成部分是减压技术，包括正念深度呼吸和同情的支持/倾听，以减少抑郁症和改善家庭关系，减轻了负担。通过监测压力的生理反应（即心率变异性），睡眠和活动，我们可以客观地衡量干预的结果。使用可穿戴互联网物联网（WIoT）技术，手表/戒指-智能手机-云的组合，已被证明是一个重要的提供随时间变化的证据的监测行为和生理测量的方法，与这次干预有着独特的联系。我们的初步数据显示，对WIoT的干预， CHW家庭访视者的照顾者对少数民族照顾者（拉丁裔、越南裔和韩国裔）是可接受的并且在短期内有效地减少护理者的压力和负担。加上非西班牙裔白人，建议以儿童为中心，文化和语言适当，CHW家访为基础的3个月干预有3个重要部分：1）通过正念呼吸和同情支持来减轻压力; 倾听，以改善照顾者的健康和福祉; 2）教育的技能，以改善反应 3）WIoT生理和行为监测。本6个月随机对照试验将比较结局（负担、抑郁、HRQOL、PWD行为、抑郁）自我效能）之间的干预、仅使用WIoT的注意力控制和常规护理组之间的差异基线、3个月和6个月。这种使用CHW模型和WIOT技术的干预具有有可能减少少数民族和服务不足的家庭照顾者中痴呆症患者的健康差异。