A home-based, culturally and language specific intervention for dementia family caregivers: stress reduction and education with wearable technology for health

针对痴呆症家庭护理人员的基于家庭、文化和语言的特定干预措施：利用可穿戴技术减轻压力并进行健康教育

• 批准号: 10055352
• 负责人: Jung-Ah Lee
• 金额: $ 76.32万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10055352
• 关键词: Adult; Alzheimer' s Disease; American; Asians; Behavior; Behavior monitoring; Breathing; California; Caregiver Burden; Caregivers; Caring; Cause of Death; Cellular Phone; Chronic stress; Cognitive Therapy; Communication; Community Health Aides; Data; Dementia; Dementia caregivers; Disease; Education; Family; Family Caregiver; Family Relationship; Health; Health Services Accessibility; Health Technology; Home environment; Home visitation; Impairment; Individual; Internet of Things; Intervention; Knowledge; Koreans; Language; Latino; Measures; Mental Depression; Mental Health; Methods; Minority; Modeling; Monitor; Morbidity - disease rate; Not Hispanic or Latino; Outcome; Perception; Personal Satisfaction; Persons; Physical activity; Physiologic Monitoring; Physiological; Population; Quality of life; Randomized Controlled Trials; Reporting; Research; Resources; Risk Factors; Self Efficacy; Self Management; Sleep; Sleep Disorders; Social support; Spouses; Stress; Techniques; Technology; Telephone; Testing; Time; Underserved Population; United States Public Health Service; Woman; attentional control; base; biological adaptation to stress; care giving burden; caregiver interventions; caregiving; dementia care; dementia caregiving; effective therapy; ethnic minority population; experience; health disparity; health related quality of life; heart rate variability; improved; innovation; mindfulness; mortality; multi-component intervention; physical conditioning; positive emotional state; psychoeducation; psychologic; real time monitoring; response; skills; sleep quality; smart watch; stress management; stress reduction; treatment as usual; underserved minority; wearable device

ABSTRACT Over 5.8 million Americans are living with Alzheimer's dementia, a disease with no effective treatment and no cure. Two-thirds of the caregivers for persons with dementia (PWD) are women (most often family) and a third are themselves over 65. Dementia takes a significant toll on caregivers, often resulting in chronic stress, depression, sleep disorders, poor health related quality of life (HRQOL), and early mortality due 24/7 care responsibility for PWD. Research has shown significant barriers to dementia care for underserved populations, including Latinos and Asian minorities. Underserved family caregivers for PWD tend to underutilize public health services available, and do not seek treatment until the situation is unmanageable with current resources reporting barriers that included language, time, and finances. Monitoring the caregiver's health and wellbeing is important as well as their maintaining a positive interaction with the PWD. Thus, there is a need for an innovative and feasible intervention to improve underserved caregiver's mental and physical health. Little research is reported for dementia caregiver interventions in underserved minorities and one given at home by community health workers (CHWs). The proposed intervention meets the needs of these family caregivers in developing a positive relationship with the PWD by educating caregivers to better understand the PWD's behaviors. Another component of the intervention is stress reduction techniques, including mindful deep breathing and compassionate support/listening to reduce depression and improve family relationships making the caregiving less burdensome. By monitoring the physiological responses of stress (i.e. heart rate variability), sleep and activity, we can objectively measure changes as a result of the intervention. Using Wearable Internet of Things (WIoT) technology, a combination of Watch/ring-Smartphone-Cloud, has proven to be a significant method of monitoring behavioral and physiological measures providing evidence of change over time and uniquely associated with this intervention. Our preliminary data show that the intervention with WIoT brought to the caregiver by CHW home visitors was acceptable to ethnic caregivers (Latino, Vietnamese, and Korean) and effective in reducing caregiver stress and burden over the short term. With the addition of non-Hispanic Whites, the proposed caregiver-centered, culturally and language appropriate, CHW home-visit-based 3-month intervention has 3 significant parts:1) stress reduction by mindful breathing and compassionate support/ listening to improve caregiver's health and well-being; 2) education on caregiving skills to improve responses to the PWD and in turn their behaviors; 3) WIoT physiological and behavioral monitoring. This 6-month randomized controlled trial will compare outcomes (burden, depression, HRQOL, PWD behaviors, caregiving self-efficacy) between the intervention, attention control with use of the WIoT only, and usual care groups at baseline, 3 months, and 6 months. This intervention using the CHW-model and WIOT technology has the potential to lessen health disparities in dementia caregiving in ethnic and underserved family caregivers.

摘要 超过580万美国人患有阿尔茨海默氏症，这种疾病没有有效的治疗方法，也没有 解药。三分之二的痴呆症(PWD)患者的照顾者是女性(通常是家人)，三分之一是女性 他们自己都超过65岁。痴呆症会给照顾者带来巨大的损失，通常会导致长期的压力， 抑郁症、睡眠障碍、与健康相关的生活质量差(HRQOL)，以及应全天候护理的早期死亡 对残障人士的责任。研究表明，对服务不足的人群进行痴呆症护理存在重大障碍， 包括拉丁裔和亚裔少数民族。残疾人服务不足的家庭照顾者往往没有充分利用公众 提供卫生服务，在现有资源无法控制情况之前不寻求治疗 报告障碍包括语言、时间和资金。监测照顾者的健康和福利是 重要的是他们与残疾人保持积极的互动。因此，需要一种 创新和可行的干预措施，以改善服务不足的照顾者的心理和身体健康。一点儿 据报道，一项针对服务不足的少数族裔的痴呆症照顾者干预的研究，以及由 社区卫生工作者(CHW)。拟议的干预措施满足了这些家庭照顾者在#年的需求 通过教育照顾者更好地了解残疾人的情况，与残疾人建立积极的关系 行为。干预的另一个组成部分是减压技巧，包括深思熟虑 呼吸和同情的支持/倾听，以减少抑郁和改善家庭关系 照顾孩子的负担更轻。通过监测应激的生理反应(即心率变异性)， 睡眠和活动，我们可以客观地衡量干预后的变化。使用可穿戴式互联网 事实证明，手表/戒指-智能手机-云相结合的物联网(WIoT)技术是一项重要的 提供随时间变化的证据的行为和生理测量的监控方法 独一无二地与这次干预有关。我们的初步数据显示，对WIoT的干预带来了 CHW家庭访客的照顾者可以被种族照顾者(拉丁裔、越南人和韩国人)接受 并在短期内有效地减轻照顾者的压力和负担。随着非西班牙裔的加入 白人，建议的照顾者以文化和语言为中心，以CHW家访为基础，为期3个月 干预有3个重要部分：1)通过有意识的呼吸和同情的支持来减轻压力/ 倾听改善照顾者的健康和幸福感；2)关于照看技能的教育，以改善反应 3)WIoT生理和行为监测。这6个月 随机对照试验将比较结果(负担、抑郁、HRQOL、PWD行为、照顾 自我效能感)在干预组、只使用WIoT的注意力控制组和日常护理组之间 基线、3个月和6个月。这种使用CHW模型和WIOT技术的干预具有 有可能缩小少数民族和未得到充分服务的家庭照料者在痴呆症护理方面的健康差距。