Medication Administration and Chemical Restraints in Family Caregiving for Alzheimer's Disease and Related Dementia

工程摘要 所有患有阿尔茨海默病和相关痴呆症（ADRD）的人都会经历以下行为症状： 痴呆症（BSD）。BSD的管理是护理人员执行的最常见的日常任务之一，其中包括 决定何时“根据需要”服用药物来解决BSD。非药物策略是 推荐的一线方法来管理BSD，虽然“根据需要”的药物可以保证当非 药理学策略失败，BSD要么给护理接受者造成痛苦，要么危及患者的健康。 照顾对象或照顾者的人身安全。相反，化学抑制意味着药物被 给药是为了使护理者更方便，而不是因为它是医学上的指示。我们的团队 据报道，22%的ADRD家庭护理人员不适当地使用药物作为化学约束。 重要的是，没有基于证据的适应症用于患者的药物治疗 为了照顾者的利益，除了安全之外。这一高水平的表现令人担忧， 这是一场新出现的公共卫生危机，也是一个重大的知识缺口。考虑到这一新的 描述的现象，这项研究的目的是描述模式的药物管理，化学 限制，以及相关的死亡率结果在ADRD家庭的治疗。为了解决这个问题，我们将进行31- 一项为期一天的微纵向研究，其中家庭护理人员（N=300）完成描述BSD的每日日记 管理，包括使用非药物策略和药物。这些数据将得到补充 与通过入组调查获得的照顾者的个人特征， 在EHR中找到的护理接受者的信息，并与关于护理接受者死亡率的生命记录数据相结合。这 拟议的研究将实施一种创新的算法，将药物管理分类为医疗 考虑到尝试的非药物策略， 安全问题和护理接受者的痛苦（目标1）。这项研究还将描述化学物质的模式， 建立化学约束使用者的类型学并确定其特征（目标2）， 使用化学约束与护理接受者1年死亡率之间的关系（目标3）。本研究 建立敏感的临床评估的第一步，以确定不良反应的高风险情况， 与实践相关的成果。这项基础性工作将支持长期研究目标， 评估是否将护理人员随机化进行化学约束筛查会导致发病率更大程度地降低， 死亡率高于观察到的危害。

Project Abstract All persons with Alzheimer’s disease and related dementias (ADRD) will experience behavioral symptoms of dementia (BSD). Management of BSD is one of the most frequent daily tasks caregivers perform, which includes deciding when to administer an “as needed” medication to address BSD. Non-pharmacologic strategies are the recommended first-line approach to manage BSD, though “as needed” medications can be warranted when non- pharmacologic strategies fail and the BSD are either causing distress to the care recipient or jeopardizing the physical safety of the care recipient or caregiver. Conversely, chemical restraint means a drug is being administered to make care more convenient for the caregiver, not because it is medically indicated. Our team has reported that 22% of ADRD family caregivers inappropriately administer medications as chemical restraints. Importantly, there are no evidence-based indications for pharmacotherapeutic management of a patient symptom for the benefit of a caregiver, aside from safety. Thus, this high prevalence is concerning, and represents an emerging public health crisis and major gap in knowledge. Given the novelty of this newly described phenomenon, the purpose of this study is to describe patterns of medication administration, chemical restraint, and associated mortality outcomes in ADRD family caregiving. To address this, we will conduct a 31- day micro-longitudinal study in which family caregivers (N=300) complete daily diaries describing BSD management including use of non-pharmacologic strategies and medications. These data will be supplemented with personal characteristics of the caregivers obtained through an enrollment survey, clinical characteristics of care recipients found in their EHR and combined with vital records data on the care recipient’s mortality. This proposed study will implement an innovative algorithm to classify medication administration as medically indicated, potentially inappropriate and chemical restraint in consideration of non-pharmacologic strategies tried, safety concerns, and distress of the care recipient (Aim 1). This study will also characterize patterns of chemical restraint to create typologies and determine characteristics of chemical restraint users (Aim 2), and determine the relationship between chemical restraint use and 1-year mortality of the care recipient (Aim 3). This study is the first step towards creating sensitive clinical assessments to identify situations at high risk of adverse outcomes related to caregiving practices. This foundational work will support a long-term research goal to evaluate if randomizing caregivers to screening for chemical restraint results in greater reduced morbidity and mortality for care recipients than the observed harms.