Reasoning Exercises in Assisted Living (REAL)

描述(由申请人提供)：居住在辅助生活(AL)设施中的老年人人口预计在未来十年增长到200万(Mollica&Johnson-Lemarche，2005)。居住在AL的老年人会经历渐进性的认知衰退和自我护理能力丧失，这就需要在平均1-3年内到疗养院(NH)进行更昂贵和更严格的护理(Golant，2004)。日常能力模型描述了认知技能如何与老年人解决问题的能力和日常生活活动(ADL)的自我照顾能力联系在一起，这些能力是保持AL所必需的。认知训练对解决问题和自我照顾能力的保护作用已经在认知完好的社区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AL患者的认知和自我照顾。本研究将测试认知训练对AL住院医师的日常问题解决、自我照顾和NH家庭安置的影响。这项研究将测试一种新的认知干预，即辅助生活中的推理练习，这是专门为AL患者设计的。这项干预是仿照归纳推理技能，在健康、独立的老年人中发现在5年内改善认知和保持自我照顾(Willis等人，2006年)。REAL教授推理和应用解决问题的技能，使AL的居民能够解决必要的问题，以保持自我护理，将延误NH安置(威利斯，1991,1996)。REAL在一项初步研究中成功地提高了AL住院医生的问题解决分数(Williams，2008)。在干预前后收集问题解决绩效和自我护理措施，并在3个月和6个月进行随访。采用线性混合建模的方法，比较真实实验组、维生素安慰剂教育组和非治疗对照组在解决日常问题和自我护理方面的表现。6个月后比较两组的AL住院时间和NH安置情况。影响问题解决和自我照顾的二级居民和设施因素将作为协变量进行测试。成本效益分析将评估提供改善自我护理的实际比率的成本。这项研究测试了一种认知训练干预措施，针对有轻度认知障碍的AL住院患者、不断扩大的有认知能力下降风险的虚弱老年人和促使NH安置的自我照顾残疾。这项研究的目标是国家护理研究所(NINR)通过将行为干预转化为临床环境来促进健康，以造福老年人和健康人2010年增加健康寿命的目标。长期目标是提供认知培训，以增加住院患者在AL的停留时间，并确定可以修改的其他因素(例如抑郁症)，以推迟NH安置并降低老年人的护理成本。 与公共健康相关：这项研究测试了对辅助生活设施居民的认知培训干预，辅助生活设施是一种快速增长的虚弱老年人人口，他们经历了渐进性认知和自我照顾能力的下降，这有助于养老院的安置。这项研究的目标是国家护理研究所(NINR)通过将行为干预转化为临床环境来促进健康，以造福老年人和健康人2010年增加健康寿命的目标。长期目标是提供有针对性的认知训练，以促进自我照顾，并最终推迟从AL安置NH，这将使体弱老年人的医疗费用每年减少50%以上。

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.