Reasoning Exercises in Assisted Living (REAL)

描述（由申请人提供）：居住在辅助生活（AL）设施的老年人人口预计将在未来十年内增长到200万（Mollica & Johnson-Lemarche，2005）。居住在AL的老年人经历了进行性认知下降和自我护理障碍，需要在平均1-3年内在疗养院（NH）进行更昂贵和更密集的护理（Golant，2004）。日常能力的模型描述了认知技能如何与老年人的问题解决和日常生活活动（ADL）的自我护理能力相关联，这些能力是保持AL所必需的。认知训练对问题解决和自我护理表现的保护作用已经在认知完整的社区居住老年人中得到了经验验证（Willis等人，2006年）。因此，需要研究来确定认知训练是否会改善患有轻度认知障碍的阿拉巴马州居民的认知和自我护理。本研究将测试认知训练对AL居民日常问题解决，自我护理和NH家庭安置的影响。 这项研究将测试一种新的认知干预，辅助生活推理练习（真实的），专门为AL居民设计。该干预是在发现在健康、独立的老年人中改善认知并维持自我护理超过5年的归纳推理技能之后建模的（Willis等人，2006年）。真实的教授推理和应用解决问题的技能，使AL居民能够解决维持自我照顾所必需的问题，这将延迟NH安置（威利斯，1991年，1996年）。在一项初步研究中，真实的成功地提高了AL居民的问题解决得分（威廉姆斯，2008）。 将在干预前后收集解决问题的表现和自我护理措施，并在3个月和6个月进行随访。将使用线性混合模型比较真实的实验组、安慰剂维生素教育组和无治疗对照组的日常问题解决和自我护理表现。AL住院时间和NH安置时间将在6个月后进行比较。影响问题解决和自我护理的次要居民和设施因素将作为协变量进行检验。成本效益分析将评估提供真实的的成本与改善自我保健的比例。 这项研究测试了认知训练干预的AL居民轻度认知障碍，不断扩大的人口体弱老人谁是认知能力下降和自我照顾能力障碍的风险，促使NH安置。这项研究的目标是国家护理研究所（NINR）的目标，通过将行为干预转化为临床环境来促进健康，以使老年人受益，以及健康人2010年的目标，即增加健康寿命。长期目标是提供认知培训，以增加AL的住院时间，并确定可以修改的其他因素（例如抑郁症），以延迟NH安置并降低老年人的护理成本。 公共卫生相关性：这项研究测试了辅助生活设施居民的认知训练干预，这是一个快速增长的体弱老人人口，他们经历了渐进的认知和自我护理下降，这有助于养老院安置。这项研究的目标是国家护理研究所（NINR）的目标，通过将行为干预转化为临床环境来促进健康，以使老年人受益，以及健康人2010年的目标，即增加健康寿命。长期目标是提供有针对性的认知训练，以促进自我护理，并最终推迟从AL的NH安置，这可以减少每年超过50%的体弱长者的医疗保健成本。

DESCRIPTION (provided by applicant): The population of older adults residing in Assisted Living (AL) facilities is expected to grow over the next decade to 2 million (Mollica & Johnson-Lemarche, 2005). Older adults who reside in AL experience progressive cognitive decline and self-care disability that necessitate the more costly and intensive care of a nursing home (NH) within an average of 1-3 years (Golant, 2004). The model of everyday competence describes how cognitive skills are linked to older adults' problem solving and self-care competency for activities of daily living (ADLs) necessary to remain in AL. Protective effects of cognitive training on problem solving and self-care performance have been empirically verified for cognitively-intact, community-dwelling elders (Willis et al., 2006). Thus, research is needed to determine whether cognitive training will improve cognition and self- care for AL residents who suffer from mild cognitive impairments. This study will test the effects of cognitive training on AL residents' everyday problem solving, self-care, and NH home placement. This study will test a new cognitive intervention, Reasoning Exercises in Assisted Living (REAL), designed specifically for AL residents. The intervention was modeled after the inductive reasoning skills found to improve cognition and maintain self-care over 5 years in healthy, independent older adults (Willis et al., 2006). REAL teaches reasoning and applied problem solving skills to empower AL residents to solve problems essential to maintain self-care that will delay NH placement (Willis, 1991, 1996). REAL successfully improved problem solving scores of AL residents in a preliminary study (Williams, 2008). Problem solving performance and self-care measures will be collected before and after the intervention with follow-ups at 3 and 6 months. Linear mixed modeling will be used to compare the REAL experimental group, a placebo VITAMIN education group, and a no treatment CONTROL group on everyday problem solving and self-care performance. Length of AL residency and NH placement will be compared between groups after 6 months. Secondary resident and facility factors that influence problem solving and self-care will be tested as covariates. Cost-effectiveness analysis will evaluate costs of providing REAL in ratio to improved self-care. This study tests a cognitive training intervention for AL residents with mild cognitive impairments, an expanding population of frail elders who are at risk for cognitive decline and self-care disability prompting NH placement. This study targets National Institute of Nursing Research (NINR) goals of promoting health through translation of behavioral interventions to clinical settings to benefit older adults and the Healthy People 2010 goals of increasing years of healthy life. The long-term goal is provide cognitive training to increase resident length of stay in AL and to identify other factors (e.g. depression) that can be modified to delay NH placement and reduce costs of care for older adults. PUBLIC HEALTH RELEVANCE: This study tests a cognitive training intervention for residents of Assisted Living facilities, a rapidly expanding population of frail elders who experience progressive cognitive and self-care decline that contributes to nursing home placement. This study targets National Institute of Nursing Research (NINR) goals of promoting health through translation of behavioral interventions to clinical settings to benefit older adults and the Healthy People 2010 goals of increasing years of healthy life. The long-term goal is to provide targeted cognitive training to promote self-care and ultimately to delay NH placement from AL, which could reduce health care costs for frail elders by over 50% per year.