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: 10449015
• 负责人: Kylie Nicole Meyer
• 金额: $ 79.48万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10449015
• 关键词: Active Learning; Address; Adult; Affect; African American; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Area; Awareness; Beds; Behavior Therapy; Behavioral Model; Behavioral Symptoms; Belief; Black American; 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; Effectiveness; Elderly; Ethnic Origin; Family; Family Caregiver; Feedback; Gait; Gender; Gerontology; Goals; Health; Health Professional; Health education; Healthcare; Intervention; Knowledge; Latinx; Learning Skill; Mediator of activation protein; 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; Pre-Post Tests; 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; arm; base; black women; care outcomes; care recipients; caregiver depression; caregiver interventions; caregiving; cognitive change; community setting; comparative efficacy; dementia care; dementia caregiving; depressive symptoms; design; 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; post intervention; preservation; programs; psychoeducation; psychoeducational; psychological symptom; response; secondary outcome; skills; symposium; theories; trial comparing

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%)的家庭照顾者为阿尔茨海默病和相关痴呆症患者提供照顾 (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，处理吞咽困难)。然而，只有53%的AD/ADRD照顾者接受过任何培训 为他们进行复杂的护理做好准备。因此，AD/ADRD照顾者体验到高度的担忧 关于犯了一个错误。对照顾者对复杂护理培训的需求的大多数反应并不是专门针对 AD/ADRD照顾者，尽管在AD/ADRD的背景下，复杂的护理具有指数级的挑战性。 由于出现痴呆的行为症状，向这一人群提供复杂的护理变得复杂 (BPSD)，由于认知变化而导致的沟通困难，以及比 在认知完好的老年护理接受者中发现。当前对照顾者的反应的另一个限制 复杂护理培训的需要是目前的资源没有完全整合已知的心理教育原则 有效地提高照顾者的自我效能感。高度的自我效能感，一个人对自己能力的信念 完成一项特定的任务，与对照料的更积极的看法(例如，意义)有关， 而低自我效能感则会导致情绪困扰，包括抑郁。培养照顾者的自我效能感 在关于复杂护理的表演中，共同学习技能(LST)于2017年在德克萨斯大学健康中心制定 圣安东尼奥由一个具有护理、职业方面专业知识的多学科团队照顾护理者计划 治疗学、语言病理学、营养学、牙科卫生学和老年学。在它的最新版本LST中 通过4个同步视频会议会议和节目内容集成原则在线提供 自我效能感理论，如同伴学习、建模和任务，以便照顾者能够练习技能 并访问反馈。在LST的单臂测试前和测试后的试点研究中，我们观察到有统计学意义 干预后4周自我效能感提高(p=0.003)。近乎显著的影响在8周后持续 干预(p=0.057)。为了严格测试参加LST对照顾者自我效能的影响，我们 建议对参与LST的中期AD/ADRD患者的照顾者进行假设检验 将报告与随机主动对照组(N=200)相比，自我效能感有更大的改善。我们 还将测试我们预期将受到自我效能提高影响的次要结果，包括 照顾者抑郁与BPSD的评定。亚组分析将与非裔美国人/黑人进行， 拉丁裔和女性照顾者；种族、民族和性别将作为干预效果修饰物进行测试 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 特点。如果研究结果证明了共同学习技能的有效性，下一步将检查 在社区环境中(例如，地区老龄机构)提供该计划时的有效性。