Teaching Resourcefulness to Women Caregivers of Elders with Dementia

描述（由申请人提供）：向老年痴呆症女性护理人员传授智谋能力这项r21探索性研究资助的主要目标是试点测试和完善一种适应性干预措施，向老年痴呆症女性护理人员（CGs）传授智谋能力。机智训练（RT）干预具有很强的理论基础，并且有初步的经验证据表明其在减轻压力、减少抑郁症状和促进除女性痴呆cg外人群的最佳生活质量方面的有效性。这项为期2年的试点研究将提供定性和定量数据，以确定两种创新设计的RT方法的必要性、可接受性、可行性、保真度、安全性和有效性，并在120名女性痴呆患者的部分随机偏好试验的背景下进行。在RT中，两种被测试的方法（表达性写作，EW）和口头披露，VD)被用来练习/加强机智技能。然而，由于研究表明，EW和VD都可能是有效的减压技术，我们也将检查没有RT的效果。我们建议，EW或VD强化的RT将为老年人提供管理压力和保持身心健康的基本技能，同时为他们的老年护理对象（CRs）提供护理。将在干预后基线（T1）、1周（T2）和6周（T3）收集有关压力、认知、情绪、机智以及身心健康的定量数据。定性数据将从CG日志(EW) /记录（VD）、数据采集人员的现场记录、后续日志等中获得。基线智多能量表（RS）得分和来自日志/记录的定性数据将用于检查RT的必要性。将随机分配到“随机”或“选择”条件中，并检查其数据（即日志、记录、现场笔记、随访日志、参与/保留日志），以确定RT的可接受性、可行性和保真度。将监测RT的安全性，以防止不良事件和心理困扰或虐待老人的报告。RT-EW和RT-VD的有效性（与没有RT的EW和VD相比）将根据应变理论建议的时间间隔以及CG， CR和CG情况内的因素来检查具体结果。最重要的是，我们将了解给心血管患者选择EW或VD加RT或不加RT是否能改善他们的预后。从六个干预参数的关键检查中得出的结论将在一项全规模随机对照试验中进一步完善和测试痴呆cg的RT。一旦确定，这种干预措施将有助于促进痴呆症社区护理人员的最佳健康功能，使他们能够在不牺牲自身健康的情况下继续为其社区护理人员提供充分的护理，并避免将老年人安置在长期护理机构中。痴呆症是美国老年人面临的最大挑战之一，几十年来，痴呆症护理的公共卫生意义已经渗透到科学和非专业文献中。尽管有许多临床试验测试了减轻照顾者压力的干预措施，但没有一项试验测试了教他们应变能力的方法，也没有一项试验允许照顾者选择首选的干预措施。本研究所测试的干预措施“智谋训练”是一种成本效益高、易于使用的方法，可减轻照顾者压力，促进其最佳心理健康。

DESCRIPTION (provided by applicant): Teaching Resourcefulness to Women Caregivers of Elders with Dementia The major goal of this R21exploratory research grant is to pilot test and refine an adapted intervention that teaches resourcefulness skills to women dementia caregivers (CGs). The resourcefulness training (RT) intervention has strong theoretical grounding and there is beginning empirical evidence for its effectiveness in reducing stress, minimizing depressive symptoms, and promoting optimal quality of life for populations other than women dementia CGs. The proposed 2-year pilot study will provide qualitative and quantitative data for determining the necessity, acceptability, feasibility, fidelity, safety, and effectiveness of two innovatively designed methods of RT within the context of a small partially randomized preference trial with 120 women dementia CGs. In RT, the two methods to be tested (expressive writing, EW) and verbal disclosure, VD) are used for practicing / reinforcing resourcefulness skills. However, because research has shown that both EW and VD may be effective stress-reducing techniques, we will also examine those effects without RT. We propose that RT reinforced by EW or VD will provide CGs with essential skills for managing stress and preserving mental and physical health while providing care for their elderly care recipients (CRs). Quantitative data on measures of stress, cognitions, emotions, resourcefulness, and mental and physical health will be collected at baseline (T1) and at 1 week (T2) and 6 weeks (T3) post-intervention. Qualitative data will be obtained from CG journal (EW) / recordings (VD), data collector's field notes, follow-up logs, etc. Baseline Resourcefulness Scale (RS) scores and qualitative data from journals / recordings will be used to examine the necessity of the RT. CGs will be randomized into "random" or "choice" conditions and their data (i.e., journals, recordings, field notes, follow-up logs, participation / retention logs) will be examined to determine acceptability, feasibility, and fidelity of RT. Safety of RT will be monitored for adverse events and reports of psychological distress or elder abuse. Effectiveness of RT-EW and RT-VD (compared to EW and VD without RT) will be examined in relation to specific outcomes at time intervals suggested by Resourcefulness Theory and in relation to factors within the CG, CR, and CG situation. Most importantly, we will learn whether giving CGs a choice of EW or VD with or without RT improves their outcomes. Conclusions drawn from the critical examination of the six intervention parameters will inform further refinement and testing of RT for dementia CGs in a full scale randomized, controlled trial. Once established, such interventions will be useful in promoting optimal, healthy functioning among dementia CGs so that they can continue to provide adequate care for their CRs without sacrificing their own health and avoid placement of the elder in a long term care facility. PUBLIC HEALTH RELEVANCE Dementia is one of the greatest challenges facing elders in the U.S. and the public health significance of dementia caregiving has permeated the scientific and lay literature for decades. Despite the number of clinical trials testing interventions for reducing caregiver stress, none have tested methods of teaching them resourcefulness skills and none have allowed caregivers to choose a preferred intervention. Resourcefulness Training, the intervention to be tested in this study, is a cost-effective, easy-to-use method for reducing caregiver stress and promoting their optimal mental health.