EPIC: A Group-based Intervention for Early-stage AD Dyads in Diverse Communities

EPIC：针对不同社区中 AD 早期二人组的团体干预

• 批准号: 9519784
• 负责人: DAVID W COON
• 金额: $ 73万
• 依托单位: ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-05-15 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9519784
• 关键词: Address; African American; Aging; Alaska; Alzheimer' s Disease; American; Arizona; Caregivers; Caring; Centers for Disease Control and Prevention (U.S.); Clinical Trials; Communication; Communities; Complement; Cost-Benefit Analysis; Data; Decision Making; Dementia; Dementia caregivers; Diagnosis; Diagnostic; Diagnostic Services; Distal; Early Diagnosis; Early Intervention; Early treatment; Education; Ethnic Origin; Ethnic group; Funding; Future; Gender; Health; Health Services Accessibility; Healthcare; Hispanics; Hour; Hypertension; Individual; Intervention; Intervention Studies; Knowledge; Language; Latino; Legal; Leisure Activities; Maintenance; Mediator of activation protein; Memory Loss; Mental Health; Meta-Analysis; Minority Groups; Nevada; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Outcome; Participant; Pathway Analysis; Patients; Personal Satisfaction; Persons; Pharmacological Treatment; Pilot Projects; Population; Prevalence; Process; Protocols documentation; Public Health; Quality of life; Quality-Adjusted Life Years; Readiness; Reporting; Research; Risk; Sample Size; Sampling; Science; Self Care; Self Efficacy; Services; Social support; Societies; Stress; Symptoms; Techniques; Time; Training; Translating; Translations; Voice; Waiting Lists; Well in self; Work; base; behavior change; care preference; caregiving; community intervention; cost; evidence base; family caregiving; follow-up; healthcare community; human old age (65+); improved; incremental cost-effectiveness; innovation; insight; instrument; interdisciplinary collaboration; physical conditioning; preference; primary outcome; programs; psychosocial; public health priorities; public health relevance; racial and ethnic; racial difference; secondary outcome; skills; skills training; stress management; success; systematic review

 DESCRIPTION (provided by applicant): In 2014, approximately 5.2 million Americans are living with Alzheimer's disease (AD). With the aging of our society, the US percentage of persons age 65 and older with AD is expected to grow 40% to 7.1 million by 2025. Larger increases are expected in Arizona (67.7%) and Nevada (73%), the two states targeted in the proposed project, with only Alaska estimated to have a greater increase. Estimates expand substantially when combining AD with other related dementias (ADRD). The majority of people in the US with ADRD are non- Hispanic whites (NHW); however, within racial/ethnic group, Hispanics/Latinos and African Americans are more likely to be living with ADRD. A recent systematic review and meta-analysis of ethnic/racial differences in dementia treatment, care, and research found consistent evidence that minority groups, particularly Hispanics/ Latinos, accessed dementia diagnostic services later than their NHW counterparts. The 2013 National Plan to Address Alzheimer's Disease states that identifying AD in its early stages creates advantages for early-stage people (EPs) and their care partners (CPs): for example, EPs can participate fully in legal, financial, and care decision-making; and social support can be mobilized for current and future concerns. Still, the point of diagnosis can start a cascading stress process that can negatively impact EP and CP health and emotional well-being, reinforcing the CDC's recognition of family caregiving as a national public health priority. While an emphasis on early detection and treatment in science and healthcare is growing, there is not corresponding emphasis on psychosocial interventions to address the well-being of early-stage dyads. Research to date has key limitations, including few RCTs, a focus on well-educated NHWs, limited treatment fidelity protocols, small sample sizes, and little impact on both EPs and CPs. This project addresses key limitations of previous studies by conducting an RCT with EPIC (Early-stage Partners in Care), an early-stage, group dyadic intervention, already offered in a pilot in diverse Arizona communities through community-based organizations that yielded positive EP and CP outcomes related to health and well-being. The proposed RCT, EPIC II, will expand EPIC across two states with an even more diverse sample and include maintenance of gains assessments. EPIC is an interdisciplinary collaboration of well-established community partners, a promotora network, and nationally recognized experts in AD caregiving and caregiving intervention research, implementation, and translation. Its innovation lies in a unique combination of skills training and care planning that helps EPs articulate their care values and preferences and become active decision makers with their CPs to achieve positive outcomes. EPIC builds upon a) the success of the EPIC I pilot, b) work with early-stage dyads showing EPs can respond validly and reliably about their care values and care preferences, c) intervention components in successful clinical trials (e.g., REACH, REACH II) with diverse groups of later-stage AD caregivers, and d) its group-based focus.