Intervention to Facilitate Family Caregiver Adaptation

描述(申请人提供)：家庭照料仍然是国家面临的一个主要公共卫生问题。随着婴儿潮一代的老龄化，家庭照看的需求将急剧增加，而提供者的供应却在减少。为了应对这些挑战，研究人员制定和评估了旨在支持和提高家庭照顾者能力的干预策略，但迄今很少重视正在经历照顾者职业生涯重大转变的照顾者。这项研究的目的是评估旨在提高照顾者及其安置的亲属的健康和生活质量的干预措施的效果，方法是将重点放在最近将亲属安置在长期护理机构的照顾者身上。我们小组和其他人最近发现，由于护理接受者的安置和死亡，护理职业生涯发生了转变，这表明了具有重大公共卫生意义的独特干预机会。我们的干预以最近安置亲属的照顾者为重点，旨在改善安置后常见的抑郁和焦虑，防止复杂的悲痛等死亡后的负面后果，并提高养老院居民的生活质量。这项研究设计是一项两组随机临床试验，比较积极干预条件和仅提供信息的对照组。弱势家庭照顾者将被随机分配到两种情况之一：1)在积极干预条件下，最近安置的居民的照顾者将接受针对三个方面需求的多成分干预--情绪健康、养老院的知识和程序以及临终关怀计划；2)在仅提供信息的控制条件下，照顾者将照常接受治疗，并添加关于确定需要进行积极治疗干预的领域的书面信息。干预将在6个月内进行，照顾者及其护理接受者将接受为期18个月的跟踪，每隔6个月进行一次评估。我们预计大约一半的护理接受者将在随访期内死亡，这使我们能够前瞻性地评估死亡和干预对死亡后照顾者结局的影响。这种干预预计将影响短期和长期照顾者的情绪困扰和负担，以及与丧亲有关的痛苦。

DESCRIPTION (provided by applicant): Family caregiving continues to be a major public health issue facing the nation. With the aging of the baby boomers, the demand for family caregiving will increase dramatically at the same time that the supply of providers is diminishing. To address these challenges, researchers have developed and assessed intervention strategies designed to support and enhance the capacity of family caregivers, but to date little emphasis as been placed on caregivers undergoing major transitions in their caregiving careers. The purpose of this study is to assess the effects of an intervention designed to enhance health and quality of life of caregivers and their placed relatives by focusing on caregivers who recently placed their relative in a long-term care facility. Recent findings from our group and others on transitions in the caregiving career due to care recipient placement and death suggest unique opportunities for intervention with great public health significance. Focused on caregivers who recently placed their relative, our intervention is designed to ameliorate depression and anxiety common after placement, prevent negative post-death outcomes such as complicated grief, and improve the quality of life of nursing home residents. The study design is a two-group, randomized clinical trial comparing an active intervention condition to an information-only control group. Vulnerable family caregivers will be randomly assigned to one of two conditions: 1) in the active intervention condition, caregivers of recently-placed residents will receive a multi- component intervention designed to target three areas of need - emotional well-being, knowledge and procedures of nursing homes, and end-of-life care planning; 2) in the information-only control condition, caregivers will receive treatment as usual with the addition of written information about areas of need identified for the active treatment intervention. The intervention will be delivered within a 6-month period and caregivers and their care recipients will be followed for an 18-month period with assessments occurring at 6- month intervals. We expect that approximately half of the care recipients will die during the follow-up period, enabling us to prospectively assess the impact of death and the intervention on post-death caregiver outcomes. The intervention is expected to impact both short-term and long-term caregiver emotional distress and burden as well as bereavement-related distress.