Learning Skills Together: A Randomized Controlled Trial of a Complex Care Skills Intervention to Improve AD/ADRD Caregiver Self-Efficacy

一起学习技能：复杂护理技能干预的随机对照试验，以提高 AD/ADRD 护理人员的自我效能

• 批准号: 10688576
• 负责人: Kylie Nicole Meyer
• 金额: $ 75.28万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10688576
• 关键词: Active Learning; Address; Adult; Affect; African American; Aging; Alzheimer' s Disease; Alzheimer' s disease caregiver; Alzheimer' s disease related dementia; Area; Awareness; Beds; Behavior Therapy; Behavioral Model; Behavioral Symptoms; Belief; Black race; Caregivers; Caring; Characteristics; Cognitive; Communication; Communities; Complex; Control Groups; Deglutition; Deglutition Disorders; Dementia; Dementia caregivers; Dental Hygiene; Discipline of Nursing; Disease; Educational Intervention; Educational process of instructing; Elderly; Ethnic Origin; Family; Family Caregiver; Feedback; Gait; Gender; Gerontology; Goals; Health; Health Professional; Health education; Healthcare; Intervention; Knowledge; Latinx; Learning Skill; Mediator; Medical; Medical Care Team; Medication Management; Mental Depression; Methods; Modeling; National Institute on Aging; Occupational Therapy; Outcome; Pain management; Participant; Perception; Performance; Personal Satisfaction; Persons; Pilot Projects; Population; Problem Solving; Race; Randomized; Randomized, Controlled Trials; Reporting; Research; Research Personnel; Resistance; Resources; Risk; Self Care; Self Efficacy; Speech-Language Pathology; Structure; Subgroup; Testing; Training; Treatment Efficacy; United States National Institutes of Health; Videoconferencing; Well in self; Woman; active control group; arm; care outcomes; care recipients; caregiver depression; caregiver interventions; caregiving; cognitive change; community setting; comparative efficacy; dementia care; dementia caregiving; depressive symptoms; design; effectiveness evaluation; efficacy testing; emotional distress; emotional experience; evidence base; experience; feeding; glucose monitor; group intervention; improved; intervention effect; monitoring device; multidisciplinary; multiple chronic conditions; nutrition; online delivery; peer learning; pilot test; post intervention; preservation; programs; psychoeducation; psychoeducational; psychoeducational intervention; psychological symptom; response; secondary outcome; skills; symposium; theories; videoconference

Project Summary/Abstract __________________________________________________________ Two-thirds (67%) of family caregivers to persons living with Alzheimer’s disease and related dementias (AD/ADRD) provide complex care tasks, such as medical/nursing tasks (e.g., managing medications, transferring from bed to chair, managing swallowing difficulties). Yet, only 53% of AD/ADRD caregivers receive any training to prepare them to conduct complex care. Consequently, AD/ADRD caregivers experience high levels of worry about making a mistake. Most responses to caregivers’ need for complex care training are not specific to AD/ADRD caregivers, though complex care is exponentially more challenging in the context of AD/ADRD. Provision of complex care to this population is complicated by the presence of behavioral symptoms of dementia (BPSD), difficulty with communication due to cognitive changes, and greater likelihood of multimorbidity than found amongst cognitively intact older adult care recipients. Another limitation of current responses to caregivers’ need for complex care training is current resources do not fully integrate principles of psychoeducation known to be effective at improving caregiver self-efficacy. High levels of self-efficacy, a person’s belief in their ability to accomplish a specific task, are associated with more positive perceptions of caregiving (e.g., meaningfulness), while low self-efficacy contributes to emotional distress, including depression. To build caregivers’ self-efficacy in the performance on complex care, Learning Skills Together (LST) was developed in 2017 at the UT Health San Antonio Caring for the Caregiver program by a multidisciplinary team with expertise in nursing, occupational therapy, speech-language pathology, nutrition, dental hygiene, and gerontology. In its most recent rendition, LST was delivered online over 4 synchronous videoconferencing sessions and program content integrated principles of Self-Efficacy Theory, such as peer-learning, modeling, and assignments so caregivers could practice skills and access feedback. In a single-arm pre- and post-test pilot study of LST, we observed statistically significant increases in self-efficacy at 4-weeks post-intervention (p=0.003). Near significant effects persisted 8-weeks post- intervention (p=0.057). To rigorously test the efficacy of participation in LST on caregiver self-efficacy, we propose to test the hypothesis that caregivers to persons living with mid-stage AD/ADRD who participate in LST will report greater improvements in self-efficacy compared to a randomized active control group (N=200). We will also test for secondary outcomes we anticipate will be affected by improvements in self-efficacy, including caregiver depression and appraisal of BPSD. Subgroup analyses will be conducted with African American/Black, Latinx, and women caregivers; race, ethnicity, and gender will be tested as intervention effect modifiers given prior research demonstrating differences in the effects of self-efficacy intervention according to these characteristics. If findings demonstrate the efficacy of Learning Skills Together, the next step will be to examine effectiveness when delivering this program in community settings (e.g., Area Agencies on Aging).

项目摘要/摘要____ 三分之二（67％）的家庭护理人员给患有阿尔茨海默氏病和相关痴呆症的人 （AD/ADRD）提供复杂的护理任务，例如医疗/护理任务（例如，管理药物，转移 从床到椅子，管理吞咽困难）。但是，只有53％的广告/ADRD护理人员接受任何培训 为他们准备复杂的护理。因此，广告/ADRD护理人员经历了高水平的担忧 关于犯错。对看护人对复杂护理培训需求的大多数回应并非特定 AD/ADRD护理人员，尽管在AD/ADRD的背景下，复杂的护理在指数上是更大的挑战。 痴呆症的行为症状的存在使该人群提供复杂的护理很复杂 （BPSD），由于认知变化而引起的沟通困难，多发性的可能性更大 在认知完整的老年人护理接受者中发现。当前对看护人的反应的另一个局限 需要进行复杂护理培训的需求是当前资源并未完全综合的心理教育原理已知 有效地提高护理人员的自我效能感。高度的自我效能感，一个人对自己的能力的信念 完成一项特定任务，与对护理（例如有意义）的更积极看法有关 尽管低自我效能有助于情绪困扰，包括抑郁症。建立看护人的自我效能 在复杂护理的表现中，学习技能（LST）于2017年在UT Health开发 圣安东尼奥（San Antonio）由一个具有护士专业知识，职业专业知识的多学科团队照顾护理人员计划 治疗，语言病理学，营养，牙齿卫生和细胞学。在最近的演绎中 已在线交付超过4个同步的视频会议和程序内容集成原则 自我效能理论，例如同伴学习，建模和作业，以便照顾者可以练习技能 和访问反馈。在LST的单臂前和测试后试验研究中，我们观察到具有统计学意义 干预后4周的自我效应增加（p = 0.003）。几乎重大影响持续了8周 干预（p = 0.057）。为了严格测试参与LST在护理人员自我效能上的效率，我们 提议检验以下假设，即护理人员向参加LST的中期广告/ADRD的人们 与随机活动对照组相比，将报告自我效能感的改善（n = 200）。我们 还将测试我们预期的次要结果，会受到自我有效的改善的影响，包括 护理人员抑郁症和BPSD的评估。亚组分析将与非洲裔美国/黑人进行 拉丁裔和女性照顾者；种族，种族和性别将作为给定的干预效果修饰符进行测试 先前的研究表明，根据这些研究的影响差异 特征。如果发现共同证明了学习技能的效率，下一步将是检查 在社区环境（例如，衰老的地区机构）中提供此计划时的有效性。