Person-centered decision making: Developing a choice-based preference tool for transitions in dementia care

项目摘要 在认知能力下降期间，关于护理的合理决策对于580万患有认知能力下降的成年人来说是一个关键问题。 阿尔茨海默病和相关痴呆症（ADRD）在美国。老年人（65岁及以上） ADRD患者通常被排除在护理决策之外，因为他们的痴呆症是痴呆症。很少有人知道的 ADRD老年人从家庭护理向长期护理过渡的决策过程 长期痴呆症护理（如疗养院，辅助生活和记忆护理单位），或如何最好地结合 老年人在决策过程中的ADRD。这项研究的目的是促进我们的 了解决策过程，以及影响决策的偏好，为老年人 ADRD患者及其护理人员。这一目标将通过以下目标实现：1）确定决定- 通过定性和定量评估， 与轻度至中度ADRD的老年人、照顾者和痴呆症护理提供者进行访谈， 详细了解痴呆症护理决策和相关偏好的复杂性。（二） 开发一个痴呆症护理偏好诱导工具，用于评估老年人的偏好， ADRD及其护理人员通过谨慎选择方法的新应用， 可视化方法和以人为本的设计，以确保该工具是响应老年人的需求， 成人ADRD 3)使用开发和验证的偏好获取工具，以确定 老年ADRD患者和照顾者的痴呆护理相关决策。在两年的时间里， 调查ADRD老年人对护理过渡的偏好的一致性。的 拟议的研究构成了调查新策略的基础，以保持老年人与ADRD 即使他们的痴呆症已经发作，他们仍然能够有意义地参与决策。

PROJECT SUMMARY Sound decision-making about care during cognitive decline is a critical issue for the 5.8 million adults with Alzheimer’s Disease and Related Dementias (ADRD) in the United States. Older adults (65 years and older) with ADRD often are excluded from care decisions as their dementia worsens. Little is known about the decision-making processes of older adults with ADRD concerning transitions from home-based care to long- term dementia care (e.g. nursing homes, assisted living, and memory care units), or how to best incorporate older adults with ADRD in the decision-making process. The goal of this research is to advance our understanding of decision-making processes, and the preferences that influence decision-making, for older adults with ADRD and their caregivers. This goal will be met through the following aims: 1) Define decision- making processes and key factors influencing decision-making about transitions in care through qualitative interviews with older adults with mild to moderate ADRD, caregivers, and dementia care providers to gain a detailed understanding of the complexities of dementia care decision-making and related preferences. 2) Develop a dementia care preference elicitation tool for use in assessing the preferences of older adults with ADRD and their caregivers through novel application of discreet choice methodology in conjunction with visualization methods and human-centered design to ensure that the tool is responsive to the needs of older adults with ADRD. 3) Use developed and validated preference elicitation tool to ascertain preferences for dementia care-related decisions among older adults with ADRD and caregivers. Over a two year period, investigate the consistency of preferences regarding transitions in care among older adults with ADRD. The proposed research forms the basis for investigating novel strategies to keep older adults with ADRD meaningfully involved in decision-making, even as their dementia worsens.