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).

项目总结/摘要_ 三分之二（67%）的家庭照顾者是阿尔茨海默病和相关痴呆症患者 (AD/ADRD）提供复杂的护理任务，诸如医疗/护理任务（例如，管理药物，转移 从床上到椅子，管理吞咽困难）。然而，只有53%的AD/ADRD护理人员接受过任何培训 为他们进行复杂的护理做好准备。因此，AD/ADRD护理人员经历了高水平的担忧 犯了个错误大多数对照顾者需要复杂护理培训的反应并不特定于 AD/ADRD护理人员，尽管在AD/ADRD的背景下，复杂的护理更具挑战性。 由于存在痴呆症的行为症状，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 在认知功能完好的老年人护理接受者中发现。目前对照顾者的反应的另一个局限性是， 需要复杂的护理培训是目前的资源没有充分整合心理教育的原则， 有效地提高照顾者的自我效能。高水平的自我效能感，一个人对自己能力的信念， 完成一项特定的任务，与更积极的认知有关（例如，意义）， 而低自我效能则会导致情绪困扰，包括抑郁症。建立照顾者的自我效能 在复杂护理的表现中，共同学习技能（LST）于2017年在UT Health开发 圣安东尼奥照顾照顾者计划由一个多学科的团队，在护理，职业 治疗、言语语言病理学、营养学、口腔卫生学和老年学。在最近的演出中，LST 在线交付超过4个同步视频会议和节目内容集成的原则 自我效能理论，如同伴学习，建模和任务，使照顾者可以练习技能 and access访问feedback反馈.在一项LST的单组试验前和试验后的初步研究中，我们观察到统计学显著性 干预后4周自我效能增加（p=0.003）。接近显著的效果持续8周后， 干预（p=0.057）。为了严格测试参与LST对照顾者自我效能的有效性，我们 建议检验这一假设，即参与LST的中期AD/ADRD患者的照顾者 与随机化活性对照组（N=200）相比，将报告自我效能的更大改善。我们 还将测试我们预期会受到自我效能改善影响的次要结果，包括 照顾者抑郁与BPSD评价将对非裔美国人/黑人进行亚组分析， 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饰符进行测试， 先前的研究表明，根据这些自我效能干预的效果存在差异 特色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 在社区环境中交付该程序时的有效性（例如，老龄化地区机构）。