Efficacy of the WeCareAdvisor: An Online Tool to Help Caregivers Manage Behavioral and Psychological Symptoms in Persons with Dementia

WeCareAdvisor 的功效：帮助护理人员管理痴呆症患者行为和心理症状的在线工具

• 批准号: 10247666
• 负责人: Laura N. Gitlin
• 金额: $ 75.46万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10247666
• 关键词: Address; Aggressive behavior; Agitation; Algorithms; Alzheimer' s Disease; Alzheimer' s disease related dementia; Antipsychotic Agents; Behavior; Behavior monitoring; Behavioral; Behavioral Symptoms; Caregivers; Caring; Caucasians; Communication; Complex; Control Groups; Custom; Dementia; Development; Disease; Disease Progression; Distress; Education; Electronic Mail; Environment; Etiology; Evaluation; FDA approved; Family; Family Caregiver; Family member; Frequencies; Funding; Goals; Grant; Health Personnel; Knowledge; Learning; Left; Mediator of activation protein; Motivation; Nursing Homes; Online Systems; Outcome; Pain; Persons; Pharmaceutical Preparations; Race; Randomized; Readiness; Reporting; Research; Review Literature; Risk; Sampling; Self Efficacy; Series; Severities; Societies; Spouses; Symptoms; Telephone; Testing; United States National Academy of Sciences; Waiting Lists; base; care systems; cost; dementia care; design; efficacy testing; efficacy trial; family burden; family caregiving; family support; health care service utilization; high risk; improved; mortality; novel; prevent; primary endpoint; psychological symptom; racial diversity; randomized trial; response; side effect; skills; symposium; tool; treatment group; treatment planning; usability; web-based tool

Behavioral and psychological symptoms (agitation, aggression, among many others; aka BPSD) are hallmarks of Alzheimer's disease and related dementias (ADRD). BPSD dominate disease presentation, occur across etiologies and disease trajectories, and have significant negative consequences for persons with dementia, family members, and society at-large. Although there are no FDA approved medications to treat BPSD, psychotropic medications (including anti-psychotics) are commonly used with limited efficacy and high risk. Nonpharmacologic strategies are considered first-line treatments and have proven efficacy, but families have little knowledge of and access to strategies and are left on their own to manage BPSD. In response, we developed an easy-to-use, web-based platform, WeCareAdvisor, through a previously funded NINR grant (R01 NR014200) for use by family caregivers. The tool provides caregivers with knowledge about dementia, daily tips, and a systematic approach for describing, investigating, creating and evaluating strategies using an approach we developed (DICE) that systematically guides selection of strategies to match symptom presentation. Our pilot randomized study (N=57; NIA-Stage 1) compared an initial treatment group to a 1- month waitlist control with caregivers receiving weekly telephone calls and emails encouraging tool use. This pilot demonstrated proof-of-concept with 100% of caregivers using the tool. After 1 month of use, both the initial treatment and the waitlist control groups showed significant within group benefits in caregiver (distress, confidence) and BPSD (frequency and severity) outcomes. Additionally, there was significant improvement in caregiver distress in the initial treatment group as compared to the waitlist group. Unclear, is whether prompts were necessary for tool use and/or to derive benefit. In response to PAR-18-027, we propose to test the efficacy of WeCareAdvisor (NIA - Stage II) and tool utilization in 326 diverse caregivers using a two-group, randomized design; caregivers will be assigned to immediate treatment or 3-month waitlist control groups. Our specific aims are to test: 1) Short-term efficacy (1-month) of WeCareAdvisor on caregiver distress, confidence managing BPSD, or BPSD frequency and severity; 2) Longer-term efficacy (3-months) of WeCareAdvisor on caregiver distress, confidence managing BPSD, or BPSD frequency and severity. We will also examine whether the waitlist control group demonstrates similar benefits after using the tool over a 3-month exposure; and 3) Tool utilization and outcomes using different reminders (telephone + email or email only). We will also evaluate whether tool utilization is sustained without prompts in months 3-6 for the initial treatment group. Exploratory aims will examine frequency of use of tool components, impact on psychotropic medication use, function, and other outcomes; and mediator (theoretically-derived variables), and moderator (race, relationship) effects. This proposal is novel in assessing efficacy and utilization of a tool that has great potential to impact dementia care by providing caregivers with on-demand access to BPSD management strategies.

行为和心理症状（激动、攻击性等；又名 BPSD）是其标志 阿尔茨海默病和相关痴呆症（ADRD）。 BPSD 主导疾病表现，发生在 病因和疾病轨迹，并对痴呆症患者产生重大负面影响， 家庭成员和整个社会。尽管 FDA 还没有批准治疗 BPSD 的药物， 常用的精神药物（包括抗精神病药物）疗效有限且风险较高。 非药物策略被认为是一线治疗方法并且已被证明有效，但家庭 对策略知之甚少，也很少接触到策略，只能靠自己来管理 BPSD。作为回应，我们 通过先前资助的 NINR 赠款 (R01 NR014200）供家庭护理人员使用。该工具每天为护理人员提供有关痴呆症的知识 技巧，以及使用方法来描述、调查、创建和评估策略的系统方法 我们开发的方法（DICE）系统地指导选择匹配症状的策略 推介会。我们的试点随机研究（N=57；NIA-第 1 阶段）将初始治疗组与 1- 月候补名单控制，护理人员每周收到电话和电子邮件，鼓励使用工具。这 试点项目对 100% 使用该工具的护理人员进行了概念验证。使用1个月后， 初始治疗组和等候名单对照组在护理人员方面表现出显着的组内益处（痛苦、 置信度）和 BPSD（频率和严重性）结果。此外，在以下方面也有显着改善： 与候补组相比，初始治疗组的护理人员感到痛苦。不清楚，是是否提示 对于工具使用和/或获得利益是必要的。为了响应 PAR-18-027，我们建议测试 WeCareAdvisor（NIA - 第二阶段）的功效和工具利用情况，使用两组、 随机设计；护理人员将被分配到立即治疗组或等待 3 个月的对照组。我们的 具体目标是测试： 1) WeCareAdvisor 对护理人员的痛苦、信心的短期功效（1 个月） 管理 BPSD，或 BPSD 频率和严重程度； 2) WeCareAdvisor 的长期疗效（3 个月） 照顾者的痛苦、管理 BPSD 的信心或 BPSD 的频率和严重程度。我们还将检查 候补名单对照组在使用该工具超过 3 个月后是否表现出类似的好处； 3) 使用不同提醒（电话+电子邮件或仅电子邮件）的工具利用率和结果。我们还将 评估初始治疗组在第 3-6 个月内是否能够在没有提示的情况下持续使用工具。 探索性目标将检查工具组件的使用频率、对精神药物使用的影响、 功能和其他结果；和中介（理论衍生变量）和调节者（种族、关系） 影响。该提案在评估工具的功效和利用率方面是新颖的，该工具具有巨大的影响潜力 通过为护理人员提供按需获取 BPSD 管理策略来提供痴呆症护理。