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).

项目总结/摘要 __________________________________________________________ 三分之二 (67%) 的家庭照顾者患有阿尔茨海默病和相关痴呆症 （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 从床上到椅子，处理吞咽困难）。然而，只有 53% 的 AD/ADRD 护理人员接受过任何培训 使他们做好进行复杂护理的准备。因此，AD/ADRD 护理人员会感到高度担忧 关于犯错误。大多数对护理人员复杂护理培训需求的回应并不特定于 AD/ADRD 护理人员，尽管复杂的护理在 AD/ADRD 背景下更具挑战性。 由于痴呆症行为症状的存在，向该人群提供复杂的护理变得复杂 （BPSD），由于认知变化而导致沟通困难，并且比其他人更容易患多种疾病 发现于认知完好的老年护理接受者中。当前对护理人员反应的另一个限制 需要复杂的护理培训是目前的资源没有完全整合众所周知的心理教育原则 有效提高护理人员的自我效能。高水平的自我效能感，即一个人对自己能力的信念 完成特定任务，与更积极的护理观念相关（例如，意义）， 而低自我效能感会导致情绪困扰，包括抑郁。建立照顾者的自我效能 在复杂护理的表现方面，UT Health 于 2017 年开发了“一起学习技能”(LST) 圣安东尼奥照顾护理人员计划由具有护理、职业专业知识的多学科团队组成 治疗、言语病理学、营养学、牙齿卫生和老年学。在其最新版本中，LST 通过 4 个同步视频会议在线进行，节目内容综合原则 自我效能理论，例如同伴学习、建模和作业，以便护理人员可以练习技能 并获取反馈。在 LST 的单臂测试前和测试后试点研究中，我们观察到统计显着性 干预后 4 周自我效能感提高 (p=0.003)。近乎显着的效果在治疗后 8 周持续存在 干预（p=0.057）。为了严格测试参与 LST 对护理人员自我效能感的功效，我们 提议检验以下假设：参与 LST 的中期 AD/ADRD 患者的护理人员 与随机主动对照组 (N=200) 相比，参与者的自我效能感有更大的改善。我们 还将测试我们预计会受到自我效能改善影响的次要结果，包括 照顾者抑郁症和 BPSD 评估。亚组分析将针对非裔美国人/黑人进行， 拉丁裔和女性护理人员；种族、民族和性别将作为干预效果修正因素进行测试 先前的研究表明，根据这些因素，自我效能干预的效果存在差异 特征。如果研究结果证明了“共同学习技能”的有效性，下一步将是检查 在社区环境（例如老龄化地区机构）中实施该计划时的有效性。