Development and Feasibility of a Behavioral Activation Intervention to Support Independence in Older Veterans at Risk for Functional Decline

行为激活干预措施的开发和可行性，以支持面临功能衰退风险的老年退伍军人的独立性

• 批准号: 10538999
• 负责人: Meaghan A. Kennedy
• 金额: --
• 依托单位: EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-11-01 至 2027-10-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10538999
• 关键词: Activities of Daily Living; Address; Adherence; Admission activity; Age; Aging; Area; Award; Behavioral; Behavioral Model; Behavioral Sciences; Cancer Survivor; Caring; Chronic; Clinical; Clinical Trials Design; Cognition; Cognitive; Communities; Complex; Data; Development; Disease; Education; Elderly; Enrollment; Etiology; Evidence based intervention; Feedback; Funding; Future; Geriatric Psychiatry; Geriatrics; Goals; Grant; Growth; Health; Health care facility; Home; Hospitalization; Impaired cognition; Individual; Intervention; Interview; Leadership; Life; Linear Regressions; Long-Term Care; Manuals; Measures; Mental Depression; Mentors; Methodology; Methods; Mission; Modeling; Occupational Therapist; Occupational Therapy; Outcome; Participant; Physical Function; Physicians; Pilot Projects; Primary Care; Prospective Studies; Protocols documentation; Psychologist; Psychosocial Assessment and Care; Randomized; Rehabilitation therapy; Reporting; Research; Research Personnel; Risk; Role; Rural; Sampling; Social Controls; Social Functioning; Social isolation; Structure; Surveys; Target Populations; Techniques; Testing; Training; United States National Institutes of Health; Veterans; Work; Writing; acute care; adverse outcome; aged; attentional control; behavioral health; behavioral study; brief intervention; career; career development; cognitive function; design; diagnostic strategy; disability; effective intervention; efficacy trial; evidence base; experience; follow-up; functional decline; functional independence; human old age (65+); improved; innovation; mild cognitive impairment; mortality; multiple chronic conditions; novel; pilot test; pilot trial; preservation; primary outcome; programs; psychosocial; recruit; rehabilitation science; satisfaction; social; telehealth; therapy development; trend

Background: Half of all Veterans are aged 65 or older. Age and associated chronic conditions increase risk for functional limitations, defined as difficulty performing day-to-day activities. This is significant not only because older Veterans place a high priority on maintaining function, but also because the manifestation of limitations signifies elevated risk for adverse outcomes. Effective interventions are needed to help older Veterans maintain independence in the community. This project will adapt an empirically-supported psychosocial therapy for depression – behavioral activation (BA) – to promote physical, cognitive, and social functioning in community-dwelling older Veterans at risk for functional decline. As a brief intervention that increases engagement in values-aligned activities, BA is a promising approach to support functioning. Specific Aims and Methods: We will develop and pilot test a six-week telehealth-delivered BA intervention, “Behavioral Activation for Independence in Older Veterans” (ACTIVaTE). The intervention will be designed to increase engagement in meaningful activities in line with individual values. The target population is older Veterans (age ≥65) enrolled in VA primary care who are at risk for functional decline, defined as a score of ≥3 on the Vulnerable Elders Survey (VES-13). This will be accomplished over three aims: Aim 1. Adapt: We will develop ACTIVaTE based on an existing BA model (Brief Behavioral Activation Treatment for Depression-Revised) for delivery to older Veterans at risk for functional decline via VA Video Connect (VVC). Our previous experience with BA will inform the initial adaptation, incorporating perspectives from primary care, geropsychology, and occupational therapy. We will seek feedback on the preliminary manual and participant workbook via semi-structured interviews with VA psychologists (n=5), occupational therapists (n=5), and Veterans (n=5), using findings to further modify the materials. Aim 2. Refine: We will conduct an open trial of ACTIVaTE delivered via VVC in 10 older Veterans at risk for functional decline, using mixed methods to determine preliminary acceptability of the intervention. Further refinements will be made to the intervention based on findings from qualitative interviews and a satisfaction survey using the Theoretical Framework of Acceptability. Aim 3. Test: We will conduct a pilot RCT of ACTIVaTE versus attention control in 48 older Veterans with VES- 13 score ≥3 recruited from primary care. We will collect clinical measures at baseline, 6 weeks, and 12 weeks, using the Ambulatory Measure for Post-Acute Care (AM-PAC) and PROMIS Satisfaction with Social Roles and Activities as primary measures of physical, cognitive, and social functioning. We will also conduct semi- structured interviews with a purposive sample of participants based on satisfaction and adherence. Feasibility will be determined by enrollment and retention and acceptability will be determined by adherence and satisfaction, as well as by themes from qualitative interviews. Preliminary impact on AM-PAC and PROMIS will be explored through within and between groups mixed-effects linear regression models and proportions of participants who achieve minimal clinically important change in outcomes. Impact: This project will adapt an evidence-based intervention for depression (BA) for a novel purpose: promoting functional independence in older Veterans. Through VVC delivery, it has potential for scalability and implications for isolated and rural Veterans. Data will be used to inform the design of a future full-scale efficacy trial (RR&D Merit Award). In parallel with my research aims, I will obtain training in behavioral and rehabilitation science, methodology (clinical trials design and analytic techniques), grant writing and scholarly dissemination, and leadership. While supporting the development of an innovative, values-aligned treatment targeting functioning, this CDA-2 will also promote my growth into an independently-funded VA physician investigator innovating at the interface of primary care, behavioral health, and rehabilitation.

背景：所有退伍军人的一半年龄在65岁以上。年龄和相关的慢性状况增加风险 对于功能限制，定义为难以执行日常活动。这不仅很重要 因为老年退伍军人在维持功能方面高度重视 局限性表示不良后果的风险升高。需要有效的干预措施来帮助老年人 退伍军人在社区中保持独立。该项目将适应经验支持的 抑郁症的心理社会疗法 - 行为激活（BA） - 促进身体，认知和社会 在社区居住的老年退伍军人中运作，有其功能下降的风险。作为简短的干预措施 增加了对价值一致的活动的参与度，BA是支持功能的有前途的方法。 具体目的和方法：我们将开发和试点测试为期六周的远程医疗BA干预， “老年退伍军人的独立行为激活”（激活）。干预将设计为 根据个人价值观，增加参与有意义的活动。目标人群年龄较大 VA初级保健的退伍军人（≥65岁）处于功能下降的风险，定义为≥3的评分 在脆弱的长老调查（VES-13）上。这将在三个目标上实现： 目标1。适应：我们将根据现有的BA模型开发激活（简短的行为激活 抑郁症的治疗）将通过VA视频降低功能下降的老年退伍军人。 连接（VVC）。我们以前在BA的经验将为最初的改编提供信息，并结合观点 来自初级保健，高科技和职业疗法。我们将寻求有关初步的反馈 通过与VA心理学家的半结构化访谈（n = 5），职业的手册和参与工作簿 治疗师（n = 5）和退伍军人（n = 5），使用发现进一步修改材料。 AIM 2。完善：我们将对通过VVC在10位老年退伍军人中通过VVC进行激活的开放试验 功能下降，使用混合方法来确定干预的初步可接受性。更远 将根据定性访谈的发现和满意的结果对干预进行改进 使用可接受性的理论框架进行调查。 AIM 3。测试：我们将在48名具有VES-的老年退伍军人中进行激活与注意力控制的试点RCT 从初级保健中招募的13分≥3。我们将在基线，6周和12周时收集临床措施， 使用急性后护理（AM-PAC）的卧床措施和对社会角色和满意 活动作为身体，认知和社会功能的主要衡量。我们还将进行半 基于满意度和依从性的自然参与者样本的结构化访谈。可行性 将由入学率和保留和可接受性确定，将取决于依从性和 满意度以及定性访谈的主题。对AM-PAC和PROMIS的初步影响将 通过组内和之间的混合效应线性回归模型和比例进行探索 实现最小临床上重要变化的参与者。 影响：该项目将以新的目的调整基于证据的抑郁措施（BA）： 促进老年退伍军人的功能独立性。通过VVC的交付，它具有可伸缩性和 对孤立和粗糙的退伍军人的影响。数据将用于告知未来全尺度效率的设计 审判（RR＆D优异奖）。与我的研究目的同时，我将获得行为和康复的培训 科学，方法论（临床试验设计和分析技术），赠款写作和科学传播， 和领导。同时支持创新，价值一致的治疗靶向的开发 功能功能，该CDA-2还将将我的增长促进由独立资助的VA物理研究者 在初级保健，行为健康和康复的界面上进行创新。