Characterizing Alzheimers Disease and Serious Mental Illness Co-Occurrence Among Nursing Home Residents and Relationship to Symptomatology and Care Practices

疗养院居民中阿尔茨海默病和严重精神疾病同时发生的特征及其与症状学和护理实践的关系

• 批准号: 10601879
• 负责人: Laura Marie Block
• 金额: $ 3.85万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10601879
• 关键词: Accounting; Address; Admission activity; Adult; Age; Aging; Alzheimer' s Disease; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Antidepressive Agents; Antipsychotic Agents; Assessment tool; Behavior; Behavioral Symptoms; Bipolar Disorder; Caring; Characteristics; Clinical; Cognitive; Complex; Data; Data Set; Dementia; Development; Diagnosis; Discipline of Nursing; Disease; Disease Progression; Distal; Educational Status; Effectiveness; Elderly; Ethnic Origin; Exhibits; Formal caregiver; Future; Goals; Home Nursing Care; Impaired cognition; Individual; Intervention; Interview; Knowledge; Link; Long-Term Care; Major Depressive Disorder; Managed Care; Methods; Modeling; National Institute on Aging; Nurses; Nursing Homes; Outcome; Pain; Pain management; Pattern; Perception; Persons; Pharmaceutical Preparations; Play; Prevalence; Provider; Psychiatric therapeutic procedure; Public Health; Quality of Care; Quality of life; Race; Research; Research Design; Research Priority; Resources; Risk; Role; Safety; Schizophrenia; Scientist; Shapes; Social Workers; Symptoms; Techniques; Testing; Training; Variant; Vulnerable Populations; adverse outcome; behavioral impairment; burden of illness; career; comorbidity; dementia care; design; disorder risk; experience; falls; functional decline; functional disability; functional status; improved; improved outcome; person centered; programs; psychologic; psychosocial; restraint; severe mental illness; sex; skills; symptom management; symptomatology

PROJECT SUMMARY/ABSTRACT Individuals with Alzheimer’s disease and related dementias (ADRD) experience progressive cognitive decline and behavioral and functional impairment. With disease progression, individuals with ADRD also experience heightened risk for poor outcomes which often culminate in the need for skilled care provided in nursing homes (NH); almost all individuals with ADRD will receive short- or long-term NH care at some point. While providing high-quality, person-centered ADRD care is a national priority, progress toward this goal is limited in part by a lack of understanding regarding the influence of major comorbidities on ADRD disease burden, care needs, and symptoms. In particular, comorbid serious mental illness (SMI), which is common among individuals with ADRD, remains understudied despite its impact on disease risk, burden, care needs, and symptomatology. Burden of both ADRD and SMI is particularly high in NH settings. Understanding whether SMI plays an additive role in shaping behavioral symptom presentation among individuals with ADRD, care needs (e.g. pain), and outcomes (e.g. falls) can inform intervention targets and improve person-centered care across settings. Towards this end, I propose a mixed methods sequential explanatory design to investigate the contribution of SMI to ADRD symptoms, outcomes, and care interventions; domains informed by the Need-Driven, Dementia-Compromised Behavior Model. I will utilize secondary data available through the Minimum Data Set 3.0 (MDS 3.0) (Aim 1/1A) and conduct interviews with NH staff (Aim 2). My long-term goal is to establish a program of research designing and delivering person-centered interventions for symptom management among adults with ADRD and complex comorbidities. My short-term objective is to characterize ADRD/SMI’s relationship to shared and distinct symptomology, outcomes, and care interventions; and implications for individuals with ADRD and provision of person-centered care. Under Aim 1, I will describe patterns and characteristics of comorbid ADRD/SMI diagnosis among NH residents using 2019 MDS 3.0 NH assessment data (N~500,000). Applying clustering techniques, I will define underlying ADRD/SMI disease co-occurrences and their variation by demographic characteristics. I will then evaluate how distinct ADRD/SMI comorbidities are associated with unique behavioral symptoms, outcomes (e.g. falls, functional status) and care needs/interventions (e.g. medication use, restraint use) as compared to ADRD alone (Aim 1A). Under Aim 2, I will explain and extend Aim1/1a findings by conducting content analysis of interviews with NH staff (e.g. nurses, nursing assistants, social workers, providers) (N=30, total) about their perceptions of ADRD/SMI comorbidities and care of residents with complex cognitive and psychiatric care needs. Impact: Findings from the proposed study are responsive to ADRD research priorities and will provide foundational data informing targets for person-centered care interventions for patients with ADRD/SMI by illuminating the contributory role of SMI to ADRD symptoms and care. The training plan will support my broader career goal of becoming a leading clinician scientist focused on aging and ADRD care.

项目摘要/摘要 阿尔茨海默病和相关痴呆症(ADRD)患者的认知功能进行性下降 以及行为和功能障碍。随着疾病的发展，ADRD患者也会经历 结果不佳的风险增加，往往最终导致需要疗养院提供的熟练护理 (NH)；几乎所有ADRD患者都将在某个时候接受短期或长期的NH护理。在提供 高质量、以人为中心的ADRD护理是国家优先事项，实现这一目标的进展在一定程度上受到 对主要合并症对ADRD疾病负担、护理需求和 症状。尤其是严重精神疾病(SMI)，这在ADRD患者中很常见， 尽管它对疾病风险、负担、护理需求和症状有影响，但仍未得到充分研究。负担过重 在NH设置中，ADRD和SMI都特别高。了解SMI在以下方面是否起到附加作用 在有ADRD、护理需求(如疼痛)和结果的个体中塑造行为症状表现 (例如，跌倒)可以告知干预目标，并在不同环境中改善以人为中心的护理。为此， 采用混合方法的序贯解释设计，考察SMI对ADRD的贡献 症状、结果和护理干预；由需求驱动、痴呆症损害的领域 行为模型。我将利用通过最低数据集3.0(MDS 3.0)(目标1/1 A)获得的二级数据 并与NH工作人员进行面谈(目标2)。我的长期目标是建立一个研究设计计划 为成人ADRD和复合体患者提供以人为中心的症状管理干预措施 合并症。我的短期目标是将ADRD/SMI的关系描述为共享和独特的 症状、结果和护理干预；对ADRD患者的影响和提供 以人为本的关怀。在目标1下，我将描述并发ADRD/SMI诊断的模式和特征 在使用2019年MDS 3.0 NH评估数据的NH居民中(N~500,000)。应用集群技术，即 将确定潜在的ADRD/SMI疾病并存及其按人口统计特征的变化。我 然后将评估ADRD/SMI共病与独特的行为症状之间的关系， 结果(例如跌倒、功能状态)和护理需求/干预(例如药物使用、约束使用) 与仅有ADRD(目标1A)相比。在目标2下，我将通过以下方式解释和扩展Aim1/1a的调查结果 与NH工作人员(例如护士、护理助理、社会工作者、提供者)的访谈内容分析(N=30， Total)了解他们对ADRD/SMI共病的看法以及对患有复杂认知和疾病的居民的护理 精神护理需求。影响：拟议研究的结果符合ADRD的研究重点 并将为以人为中心的护理干预目标提供基础数据 ADRD/SMI通过说明SMI对ADRD症状和护理的贡献作用。培训计划将 支持我更广泛的职业目标，即成为一名专注于老龄化和ADRD护理的领先临床科学家。