Activation for Self-Care Needs in Older Adults with Chronic Kidney Disease: ACTIVE SENIORS with CKD

激活患有慢性肾病的老年人的自我护理需求：患有 CKD 的活跃老年人

• 批准号: 10449657
• 负责人: Devika Nair
• 金额: $ 17.57万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10449657
• 关键词: Academic Medical Centers; Active Learning; Administrator; Adult; Affect; Age; Area; Atherosclerosis; Award; Behavior; Behavior Therapy; Behavior monitoring; Behavioral; Behavioral Mechanisms; Behavioral Sciences; Biological Process; Cardiovascular system; Cessation of life; Chronic; Chronic Kidney Failure; Cognition; Cognitive deficits; Cohort Analysis; Cohort Studies; Competence; Data; Development; Dialysis procedure; Disease; Disease Progression; Dose; Elderly; Equipment and supply inventories; Event; Exercise; Frequencies; Funding; Generations; Geriatrics; Glomerular Filtration Rate; Goals; Health; Health system; Impairment; Individual; Influentials; Inpatients; Instruction; Intervention; Interview; Kidney; Kidney Diseases; Knowledge; Longitudinal cohort; Measures; Medicine; Methods; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Nephrology; Neurobiology; Neurocognitive; Odds Ratio; Outcome Measure; Participant; Patient Outcomes Assessments; Patient Preferences; Patients; Persons; Physical Exercise; Physical Function; Physical activity; Policies; Population; Principal Investigator; Problem Solving; Process; Prospective cohort; Protocols documentation; Reporting; Research; Research Personnel; Sampling; Self Care; Self Efficacy; Testing; Theory of Change; Time; Translating; Treatment Efficacy; United States; United States National Institutes of Health; adaptive intervention; atherosclerosis risk; behavior change; cardiovascular health; cardiovascular risk factor; career; cognitive function; cohort; design; executive function; federal policy; hazard; implementation intervention; implementation science; improved; innovation; interest; intervention delivery; mental state; mortality; neurobiological mechanism; novel; portability; professor; prototype; recruit; skills; therapy development; uptake; usability

PROJECT SUMMARY/ABSTRACT Dr. Devika Nair is an Assistant Professor of Medicine in the Division of Nephrology at Vanderbilt University Medical Center. With this K23, she will advance the precision, personalization, and scalability of behavioral interventions for older adults with chronic kidney disease (CKD) by developing and iteratively refining a novel, multicomponent, adaptive behavioral intervention able to be dosed in real-time. Dr. Nair will gain 1) new proficiency in behavioral science research, including analyzing cohort data containing patient-reported assessments, recruiting and retaining a new, longitudinal cohort, and developing adaptive behavioral interventions; 2) new knowledge in areas of geriatrics relevant to CKD (cognition and physical function); and 3) new competency in implementation science and mixed-methods design. An invested, integrated, and established team will support Dr. Nair's transition to independence. Dr. Kerri Cavanaugh will provide instruction in behavioral science. Dr. Warren Taylor will provide instruction in geriatrics and experiential learning in neurocognitive assessment. Dr. Daniel Cukor will provide instruction in behavioral interventions. Dr. Russell Rothman will provide instruction in implementation science. Dr. David Schlundt will provide guidance in mixed- methods design. Poor engagement in disease self-care behaviors (i.e., physical activity) leads to adverse cardiovascular events and death in older adults with CKD, the fastest growing kidney disease population. Existing interventions to improve self-care behaviors in this group are `one-size-fits-all' and do not result in durable behavior change due to inadequate tailoring and dose adjustment. Patient Activation, a modifiable measure of self-efficacy, knowledge, problem-solving skill, and level of need for behavioral support, is under- investigated in CKD despite its inclusion in CKD legislative policy. Cognitive function, the neurobiological processes requisite of goal-directed behavior and problem-solving skill, is often impaired in CKD yet its impact on engagement in disease self-care behaviors is unknown. To elucidate neurobiological and behavioral mechanisms of self-care behaviors, identify new intervention targets, and develop a novel, adaptive behavioral intervention, Dr. Nair will 1) test whether self-efficacy, Patient Activation and cognitive function associate with frequency of engagement in CKD self-care behaviors; 2) define how Patient Activation levels and CKD self- care behaviors change over time to inform intervention dosing, amount of support, and frequency; 3) identify patients' behavioral goals and triggers for ineffective self-care to inform timing and intervention component selection; 4) identify patient preferences for behavioral monitoring frequency and intervention delivery mode; 5) identify barriers and facilitators to intervention implementation into the health system; and 6) iteratively refine the prototype with usability testing. This award will inform a concurrent R03 to pilot feasibility and subsequent R01 to test intervention efficacy and advance Dr. Nair's goals to gain expertise in behavioral science, adaptive intervention development, geriatrics, mixed-methods, and implementation science.

项目摘要/摘要 本文作者是范德比尔特大学(Vanderbilt University)肾病学系医学助理教授 医疗中心。有了这款K23，她将提升行为的精确度、个性化和可扩展性 对老年慢性肾脏疾病(CKD)的干预通过开发和迭代完善一种新的、 多组分、适应性行为干预，能够实时投药。奈尔博士将获得新的 精通行为科学研究，包括分析包含患者报告的队列数据 评估、招募和保留新的纵向队列，以及发展适应性行为 干预措施；2)与慢性肾脏病相关的老年病学领域的新知识(认知和身体功能)；以及3) 具备实施科学和混合方法设计方面的新能力。投资、集成和 现有的团队将支持奈尔博士向独立的过渡。Kerri Cavanaugh博士将提供指导 在行为科学方面。沃伦·泰勒博士将在老年病学和经验学习方面提供指导 神经认知评估。Daniel Cukor博士将提供行为干预方面的指导。罗素博士 罗斯曼将提供实施科学方面的指导。David Schlundt博士将提供混合- 方法设计。缺乏疾病自我护理行为(即体力活动)会导致不良反应 患有慢性肾脏病的老年人的心血管事件和死亡，这是增长最快的肾脏疾病人群。 改善这一群体自我护理行为的现有干预措施是“一刀切”的，不会导致 由于不适当的裁剪和剂量调整，导致持久的行为变化。患者激活，一种可修改的 自我效能感、知识、解决问题的技能和对行为支持的需求程度- 在CKD被调查，尽管它被纳入CKD的立法政策。认知功能，神经生物学 目标导向行为和解决问题技能所必需的过程在CKD中往往受到损害，但它的影响 关于从事疾病自我护理的行为尚不清楚。阐明神经生物学和行为学 自我护理行为的机制，确定新的干预目标，并开发一种新的适应性行为 干预，奈尔博士将1)测试自我效能感、患者积极性和认知功能是否与 参与CKD自我护理行为的频率；2)定义患者的激活水平和CKD自我护理行为 护理行为随时间变化，以告知干预剂量、支持量和频率；3)确定 患者的行为目标和无效自我护理的触发因素，以告知时机和干预组成部分 选择；4)确定患者对行为监测频率和干预提供方式的偏好；5) 确定实施卫生系统干预措施的障碍和促进者；以及6)反复改进 进行了可用性测试的原型。该授标将通知同时进行的R03试验的可行性和后续 R01以测试干预效果并推进Nair博士的目标，以获得行为科学、适应性 干预发展、老年病学、混合方法和实施科学。