A PRESCRIPTION FOR ENHANCING RESIDENT QUALITY OF LIFE

描述(申请人提供)：居住在我国养老院的150万人中，大多数是患有痴呆症的老年人，这使他们面临健康状况不佳和生活质量下降的风险。90%的痴呆症患者表现出需要驱动的行为，如激动和被动，这是许多不良健康后果的原因，包括情绪功能不良、身体功能下降、使用约束、社会孤立和虐待风险增加。在需求驱动的痴呆症妥协行为模型(NDB)中，这些行为被概念化为由未满足的需求触发的早期行为模式的保留残留物。 为居民的技能水平和兴趣量身定做的娱乐活动有望成为激动和被动的管理策略，但还没有对治疗成分(技能水平和兴趣)进行系统检查，这些成分被假设为导致治疗结果。直到最近，还没有解决养老院居民与技能水平和兴趣相关的需求的理论框架。本研究的主要目的是测试源自NDB模式的娱乐活动在减少激动感和被动性、改善养老院痴呆症患者的参与度、情感和情绪方面的效果。这些娱乐活动将根据居民的技能水平(认知能力和身体功能)和兴趣(个性)进行单独定制。NDB衍生的活动通过解决需求驱动行为的三个重要原因来满足需求：认知能力受损、身体功能受损和患病前人格。这项研究将是一项重复措施的随机临床试验，140名居民将被随机分配到四组中的一组进行为期3周的干预。干预前后将测量激动感和被动性、参与度、情感和情绪。研究假设，接受新开发银行衍生干预的居民将比接受仅与技能匹配、仅与兴趣匹配或对照干预的居民表现出显著更少的激动感、更少的被动性、更大的参与度、更多的积极情绪和更积极的情绪。这项研究有望通过使用基于理论的活动来满足疗养院痴呆症患者的需求，从而提高他们的生活质量。

DESCRIPTION (provided by applicant): The majority of the 1.5 million individuals who reside in our nation's nursing homes are elderly persons with dementias that place them at risk for poor health outcomes and diminished quality of life. Need driven behaviors, such as agitation and passivity, are exhibited by 90% of residents with dementia, and account for many poor health outcomes, including poor emotional functioning, decline in physical functioning, use of restraint, social isolation and increased risk of abuse. In the Need-driven Dementia compromised Behavior model (NDB) these behaviors are conceptualized as preserved remnants of earlier behavioral patterns that are triggered by unmet needs. Recreational activities tailored to the skill level and interests of residents hold promise as management strategies for agitation and passivity, but there has been no systematic examination of the treatment components (skill level and interest) that are hypothesized to result in therapeutic outcomes. Until recently, no theoretical framework that addressed nursing home residents' needs related to skill level and interests was available. The primary aim of this study is to test the efficacy of recreational activities derived from the NDB model in reducing agitation and passivity and improving engagement, affect and mood in nursing home residents with dementia. These recreational activities will be individually tailored to match the resident's skill level (cognitive ability and physical functioning) and interests (personality). The NDB-derived activities meet needs by addressing three important causes of need-driven behaviors: impaired cognitive ability, impaired physical functioning and premorbid personality. This study will be a randomized clinical trial with repeated measures, in which 140 residents will be randomly assigned to one of four groups for a 3-week intervention. Measures of agitation and passivity, engagement, affect and mood will be taken before and after interventions. It is hypothesized that residents who receive the NDB-derived intervention will exhibit significantly less agitation, less passivity, greater engagement, more positive affect and more positive mood than residents who receive the match to skill only, match to interest only, or control intervention. This study holds promise for improving quality of life for nursing home residents with dementia by using theoretically based activities to respond to their needs.