Reasoning Exercises in Assisted Living (REAL)

描述（由申请人提供）：居住在辅助生活设施（AL）的老年人人口预计在未来十年将增长到200万（Mollica & Johnson-Lemarche, 2005）。居住在AL中的老年人会经历进行性认知能力下降和自我护理障碍，需要在平均1-3年内在养老院（NH）接受更昂贵的重症护理（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和自我照顾日常生活活动（adl）的能力联系起来，而这些能力是维持老年生活所必需的。认知训练对解决问题和自我照顾表现的保护作用已经在认知完好的社区居住老年人中得到了实证验证（Willis等人，2006）。因此，认知训练是否能改善患有轻度认知障碍的阿尔茨海默病患者的认知和自我护理，还需要进一步的研究。本研究旨在探讨认知训练对住院病人日常问题解决、自我照顾及住院病人安置之影响。本研究将测试一种新的认知干预，辅助生活推理练习（REAL），专门为人工智能居民设计。干预是模仿归纳推理技能，发现在健康、独立的老年人中，归纳推理技能可以改善认知和维持5年以上的自我照顾（Willis等人，2006）。REAL教授推理和应用解决问题的技能，使人工智能住院患者能够解决必要的问题，以维持自我保健，从而推迟NH的安置（Willis, 1991,1996）。在初步研究中，REAL成功地提高了人工智能居民的问题解决得分（Williams, 2008）。收集干预前后的问题解决表现和自我保健措施，并在3个月和6个月进行随访。采用线性混合模型比较REAL实验组、安慰剂维生素教育组和无治疗对照组在日常问题解决和自我保健方面的表现。6个月后，将比较两组的实习时间。影响问题解决和自我照顾的次要住院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REAL的成本与改善自我保健的比例。本研究对患有轻度认知障碍的AL居民进行认知训练干预，这是一个不断扩大的体弱多病的老年人群体，他们有认知能力下降和自我照顾障碍的风险，促使NH安置。本研究的目标是美国国家护理研究所（NINR）的目标，即通过将行为干预转化为临床环境来促进老年人的健康，并实现健康人群2010年的目标，即增加健康生活的年数。长期目标是提供认知训练，以增加住院病人在养老院的停留时间，并确定其他因素（如抑郁症），这些因素可以被修改，以推迟NH的安置，降低老年人的护理成本。

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.