Promoting Reengagement in Daily Meaningful Activity Intervention for Adults with Mild Cognitive Impairment and Their Caregivers

促进轻度认知障碍成年人及其照顾者重新参与日常有意义的活动干预

• 批准号: 10589844
• 负责人: Yueh-Feng Yvonne Lu
• 金额: $ 49.33万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-05 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10589844
• 关键词: Active Listening; Activities of Daily Living; Address; Adult; Aging; Agreement; American; Anxiety; Assisted Living Facilities; Behavior Therapy; Caregiver Burden; Caregivers; Caring; Cognitive; Communication; Communities; Control Groups; Data; Dementia; Deterioration; Effectiveness of Interventions; Elderly; Eligibility Determination; Exercise; Family; Family Caregiver; Fostering; Frustration; Future; Goals; Health; Health Promotion; Impairment; Intervention; Intervention Studies; Judgment; Knowledge; Learning; Life; Medication Management; Memory; Mental Depression; Modeling; Nurses; Outcome; Participant; Patient Care; Patient-Focused Outcomes; Patients; Perception; Performance; Persons; Pilot Projects; Problem Solving; Questionnaires; Randomized; Randomized Controlled Clinical Trials; Randomized, Controlled Trials; Reporting; Risk; Risk Reduction; Self Efficacy; Self Management; Socialization; Support Groups; Symptoms; Testing; Time; Translations; Work; acceptability and feasibility; attentional control; cognitive training; depressive symptoms; design; efficacy evaluation; empowerment; executive function; experience; improved; interest; mild cognitive impairment; multi-component intervention; nutrition; patient engagement; patient home care; prospective; satisfaction; skills; social; symptomatic improvement

PROJECT ABSTRACT This study examines efficacy of a theoretically-based, positive health focused, tailored, nurse-delivered, family- centered intervention: “Daily Engagement in Meaningful Activity” (DEMA). DEMA is designed for older persons with mild cognitive impairment (MCI) and family caregivers. Nearly 20% of Americans over 65 have MCI. Patients with MCI (patients) experience reduced life satisfaction due to patients’ increasing lack of confidence and diminished ability to perform meaningful and/or important activities, leading to diminished meaningful activity engagement, depressive symptoms, and anxiety. Caregivers lack confidence to manage their own and their patient’s daily challenges, leading to high caregiver burden, depressive symptoms, and anxiety. Patients and caregivers (dyads) report diminished satisfaction with their communication and relationship due to disagreements regarding the patient’s functional ability. Patient/caregiver behavioral interventions are more successful when they occur before progression to dementia. Previous cognitive intervention studies used limited, single domain foci (e.g., cognitive training, exercise, or nutrition) that may not be meaningful enough to sustain patient engagement long enough to improve life satisfaction. Emerging evidence, including our pilot studies, suggests regular engagement in self-identified meaningful activities can improve life satisfaction and depression and reduces risk of developing dementia. The purpose of this randomized controlled trial is to determine efficacy of DEMA compared to an information support (IS) attention control group. DEMA: 1) fosters active listening to increase dyad agreement in perceptions of patient functional ability; 2) helps dyads enhance engagement in and satisfaction with self-identified meaningful activities through problem solving to assess, prioritize, and achieve identified meaningful activity goals; 3) builds on patient’s existing interests and skills; and 4) provides information and didactic support to address priority concerns and dyad adjustment to functional changes and plan for the future. Specific aims are: 1) test DEMA’s efficacy for improve patient/ caregiver life satisfaction; 2) test DEMA’s efficacy to improve activity performance, depressive symptoms and anxiety in patients and burden, depressive symptoms, anxiety in caregivers; and, 3) explore a sub-sample of patients with higher depressive symptoms for improvement in health outcomes over time, compared to non- depressed patients. Eligible patient/caregiver dyads (n = 200) will be randomized to a 7-session DEMA or IS intervention, with data collected at baseline and 3 times over 9 months. Mixed model effects will be analyzed. If efficacious, DEMA will provide high impact on the care of patients and caregivers by maintaining their engagement in meaningful activities to improve patient and caregiver life satisfaction, depressive symptoms, anxiety, relationship satisfaction, activity performance, and caregiver burden. It will also provide information regarding the extent to which patients who have more depression may benefit and empirical evidence of the effectiveness of an intervention for translation into practice.

项目摘要