LEAD IT! An App to Enable Persons with Early Stage Dementia to Lead Group Activities for Their Peers

项目摘要 大约有100万痴呆症患者（PWD）住在长期护理（LTC），预计这一数字将 在接下来的20年里翻了一番（Gaugler等人，2019年）。痴呆症也与各种反应行为有关 （Cummings，1997年）。患有早期痴呆症（PESD）的人也经常经历生存危机，因为他们感到失落。 生活的目的（Cohen & Mrs. Dorfer，2001）。虽然PESD的其余优势已经知道了一段时间，但很少有人知道。 有机会扮演有意义的社会角色。因此，迫切需要一种具有强大商业化潜力的 该产品使PESD能够在居民主导的活动中担任小组领导。由于高速互联网、平板电脑和应用程序 已经变得无处不在，部署这样一个产品的一个有前途的方法是通过基于平板电脑的应用程序。考虑到这一点， 第1阶段SBIR，Skrajner先生[PI]开发并评估了一个名为LEAD IT！的基于平板电脑的应用程序的Alpha版本，这 使PESD能够实施居民主导的活动。第1阶段项目表明，（1）PESD能够使用 应用程序，以促进活动，（2）残疾人参与这些活动，即，居民球员（RP）-表现出高水平 积极参与，（3）驻地领导（RL）和RP都对应用程序表示高度满意。 第二阶段项目将使我们能够进一步开发和评估LEAD IT！，以及检查临床结果， RL和RP长期使用该应用程序。第二阶段项目的具体目标是：（1）开发 Lead IT的改进Beta 1（B1）和Beta 2（B2）版本！有足够的内容来促进六项活动， 每周4.5个月;（2）检查RL在使用LEAD IT时能够充当领导者的程度！(3)审查 以居民为主导的LEAD IT！（4）研究残疾人士及员工对“领导资讯科技”的满意程度！ 为了实现这些目标，将进行两个准实验。实验#1，将测试B1版本的LEAD IT！，将使用一个前后设计。将通过检查RP的参与/影响水平来评估近端（即时）效应 在基线（标准）活动期间，并再次在LEAD IT期间！活动我们假设领导它！将导致 比基线活动更高质量的参与。实验2将测试B2版本的应用程序，它将是一个集群 随机试验（CRT），包括治疗组（TG）干预前后的测量值， 将由接受干预的残疾人组成，对照组（CG）将由以下残疾人组成： 接受标准编程/护理。由于实验#2将在应用程序的所有调整完成后发生，因此它将 代表了领先IT的最终审判！App对PWD的影响对于近端（即时）测量，我们预计 检测组x时间交互作用效应，TG参与者在正相关性方面表现出显著更大的增加， 与CG参与者相比，参与形式。对于远端测量，我们预期检测到GROUP x TIME 交互作用，TG参与者在治疗时表现出DEMQOL评分的显著增加， 与CG参与者相比。经过对LEAD-IT！的全面开发和评估，这个应用程序将很好地定位， 这对许多残疾人的生活来说是一个有意义的改变。

PROJECT SUMMARY Approximately one million persons with dementia (PWD) reside in long term care (LTC), and this figure is expected to double over the next 20 years (Gaugler et al., 2019). Dementia is also associated with a variety of responsive behaviors (Cummings, 1997). Persons with early stage dementia (PESD) also often experience an existential crisis, as they feel a loss of purpose in life (Cohen & Eisdorfer, 2001). While the remaining strengths of PESD have been known for some time, few opportunities for meaningful social roles exist. So, there is an urgent need and strong commercialization potential for a product that enables PESD to serve as group leaders in resident-led activities. Since high-speed internet, tablets, and apps have become ubiquitous, one promising way to deploy such a product is through a tablet-based app. With this in mind, in a Phase 1 SBIR, Mr. Skrajner [PI] developed and evaluated an Alpha Version of a tablet-based app called LEAD IT!, which enables PESD to implement resident-led activities. The Phase 1 project demonstrated that (1) PESD were capable of using the app to facilitate activities, (2) PWD participating in such activities—i.e., resident-players (RPs)—exhibited high levels of positive engagement, and (3) both Resident-Leaders (RLs) and RPs reported high satisfaction with the app. The proposed Phase 2 project will allow us to further develop and evaluate LEAD IT!, as well as an examine the clinical outcomes of long-term use of the app by both RLs and RPs. The Specific Aims of the proposed Phase 2 project are to: (1) develop improved Beta 1 (B1) and Beta 2 (B2) Versions of LEAD IT! with sufficient content to facilitate six activities twice per week for 4.5 months; (2) examine the extent to which RLs are able to serve as leaders while using LEAD IT! (3) examine the effects of resident-led LEAD IT! programming on RPs; and (4) examine PWD and staff satisfaction with LEAD IT! To meet these aims, two quasi-experiments will be conducted. Experiment #1, which will test the B1 version of LEAD IT!, will use a pre-post design. Proximal (immediate) effects will be assessed by examining RP’s levels of engagement/affect during baseline (standard) activities and again during LEAD IT! activities. We hypothesize that LEAD IT! will result in higher quality engagement than baseline activities. Experiment #2, which will test the B2 version of the app, will be a cluster randomized trial (CRT), consisting of pre- and post-intervention measurements of a TREATMENT GROUP (TG)—which will consist of PWD who receive the intervention – and a CONTROL GROUP (CG) – which will consist of PWD who receive standard programming / care. Since Experiment #2 will occur after all tweaking of the app is completed, it will represent the definitive trial of the LEAD IT! app’s impact on PWD. For proximal (immediate) measures, we anticipate detecting a GROUP x TIME interaction effect, with TG participants exhibiting significantly greater increases in positive forms of engagement, as compared to CG participants. For distal measures, we anticipate detecting a GROUP x TIME interaction effect, with TG participants exhibiting significantly greater increases in DEMQOL scores at treatment, as compared to CG participants. After full development and evaluation of LEAD-IT!, the app will be well-positioned to make a meaningful difference in the lives of many PWD.