Reducing Disability via a Family-centered Intervention for Acutely-ill Persons with Alzheimer's Disease and Related Dementias

通过以家庭为中心的干预措施减少患有阿尔茨海默病和相关痴呆症的急性患者的残疾

• 批准号: 9330526
• 负责人: Marie Boltz
• 金额: $ 61.24万
• 依托单位: PENNSYLVANIA STATE UNIVERSITY, THE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-01 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9330526
• 关键词: Abate; Accident and Emergency department; Acute; Address; Admission activity; Advocate; Aging; Alzheimer' s Disease; Area; Attention; Attitude; Caregiver Burden; Caregivers; Caring; Clinical dementia rating scale; Cluster randomized trial; Cognitive; Communities; Cost Savings; Decision Making; Decubitus ulcer; Delirium; Dementia; Dependency; Education; Effectiveness; Elderly; Environment; Environmental Policy; Evaluation; Family; Family Caregiver; Family member; Formal caregiver; Friends; Goals; Health Care Costs; Healthcare; Home Nursing Care; Home environment; Hospital Units; Hospitalization; Hospitals; Impaired cognition; Incontinence; Individual; Intervention; Intrinsic factor; Knowledge; Length of Stay; Lifting; Long-Term Care; Malnutrition; Measures; Medical; Mental Depression; Mentors; Modeling; Modification; Moods; Morbidity - disease rate; Motivation; Nurses; Nursing Staff; Outcome; Pathway interactions; Patient-Focused Outcomes; Patients; Performance; Persons; Physical Function; Physical activity; Play; Policies; Process; Quality of life; Randomized; Readiness; Recovery of Function; Research; Research Personnel; Risk; Role; Sampling; Science; Series; Severities; Stress; Time; Voice; Walking; Work; base; behavior change; care delivery; caregiver strain; caregiving; clinically significant; cost; dementia care; disability; efficacy testing; efficacy trial; empowerment; experience; falls; functional decline; functional outcomes; health care service utilization; hospital readmission; improved; mortality; neuropsychiatric symptom; nursing home length of stay; peer; preference; prevent; programs; randomized trial; relative cost; shared decision making; social

Abstract Older persons with Alzheimer’s disease and related dementias (ADRD) are about two times as likely to be hospitalized as their peers who are cognitively healthy. The care of hospitalized persons with ADRD has traditionally focused on the acute medical problem that led to admission with little attention paid to functional recovery. Older persons with ADRD are at greater risk for functional decline and increased care dependency after discharge due to a combination of intrinsic factors, environmental, policy, and care practices that restrict physical and cognitive activity, and limited staff knowledge of dementia care. Family caregivers (CGs) can play an important role in promoting the functional recovery of hospitalized older adults. They can provide vital information, offer motivation and support of function-focused care, and assume responsibility in varying degrees for post-acute care delivery and coordination. Family- centered FFC (Fam-FFC) incorporates an educational empowerment model for family CGs provided within a social-ecological in-patient framework promoting specialized care to patients with ADRD. The intervention creates an “enabling” milieu for the person with ADRD through environmental and policy assessment/modification, staff education, unit-based champions, and individualized goal setting that focuses on functional recovery. In this patient/family-centered care approach, nurses purposefully engage family CGs in the assessment, decision-making, care delivery and evaluation of function- focused care during hospitalization and the 60-day post-acute period. In the proposed project, we will implement Fam-FFC in a cluster randomized trial of 438 patient/CG dyads in six hospital units randomized within three hospitals (73 dyads per unit) to accomplish the following aims: Aim 1: Validate the efficacy of Fam-FFC on physical function (ADLs/ performance and physical activity), delirium occurrence and severity, neuropsychiatric symptoms, and mood; Aim 2: Evaluate the impact of Fam- FFC on family CG-centered outcomes (preparedness for caregiving, strain, burden, and desire to institutionalize); and Aim 3: Evaluate the relative costs for Fam-FFC v. control condition, and calculate health care cost (post-acute health care utilization) and total cost savings for Fam-FFC. Dyads will be composed of community-residing, hospitalized medical patients with very mild to moderate dementia (0.5 to 2.0 on the Clinical Dementia Rating Scale) and their CG (defined as the primary person providing oversight and support on an ongoing basis). Outcomes will be evaluated at hospital admission, discharge, two and six months post-discharge. This study will be a critical next step in delineating how to partner with family CGs to change acute care approaches provided to patients with ADRD so as to optimize function after discharge, and promote delirium abatement and well-being in these individuals. The societal implications of helping older individuals with Alzheimer’s disease and related dementias avoid functional decline are enormous in terms of aging in place, quality of life, cost, and caregiver burden. The study findings will be relevant for other areas of behavior change research in acute care, specifically those related to engaging patients and families in health care planning, delivery, and evaluation.

摘要 患有阿尔茨海默氏病和相关痴呆症（ADRD）的老年人， 和认知健康的同龄人一样住院。ADRD住院患者的护理 传统上关注的是导致入院的急性医学问题， 功能恢复患有ADRD的老年人功能下降的风险更大， 由于内在因素、环境、政策和 限制身体和认知活动的护理实践，以及工作人员对痴呆症护理的知识有限。 家庭照顾者在促进住院患者功能恢复方面具有重要作用 老年人他们可以提供重要的信息，提供动机和支持功能为重点的护理， 并在不同程度上承担急性期后护理交付和协调的责任。家庭- 以FFC为中心（Fam-FFC）为提供的家庭CG纳入了教育赋权模型 在社会生态住院框架内，促进对ADRD患者的专门护理。的 干预通过环境和政策为ADRD患者创造一个“有利”的环境。 评估/修改，员工教育，基于单位的冠军，以及个性化的目标设定， 专注于功能恢复。在这种以病人/家庭为中心的护理方法中，护士有目的地 让家庭CG参与评估、决策、护理提供和功能评估- 住院期间和急性期后60天的重点护理。在拟议项目中，我们将 在6个医院438例患者/对照组配对中实施Fam-FFC 在三家医院内随机分组（每单位73对），以实现以下目标：目标1： Fam-FFC对身体功能（ADL/表现和体力活动）、谵妄 发生率和严重程度、神经精神症状和情绪;目的2：评估Fam- FFC对家庭CG为中心的结果（准备生育，应变，负担和愿望， 目标3：评估Fam-FFC与控制条件的相对成本，并计算 Fam-FFC的医疗保健成本（急性期后医疗保健利用）和总成本节约。二元组将是 由居住在社区的、患有非常轻度至中度痴呆症的住院医疗患者组成 (0.5临床痴呆评定量表上的2.0）和他们的CG（定义为提供 持续的监督和支持）。结果将在入院时进行评估， 出院后两个月和六个月。这项研究将是一个关键的下一步，在描绘如何 与家庭CG合作，改变为ADRD患者提供的急性护理方法， 优化出院后的功能，并促进这些个体的谵妄减轻和健康。 帮助老年阿尔茨海默病和相关痴呆症患者的社会意义 避免功能下降是巨大的方面老化的地方，生活质量，成本，和照顾者 负担研究结果将与急性护理中行为改变研究的其他领域相关， 特别是那些与患者和家属参与医疗保健计划，提供， 评价