Aggression Prevention Training for Caregivers of Persons with Dementia

描述(申请人提供)：痴呆症患者(PWD)的照顾者通常负责他们所爱的人的日常护理、协调和提供。80%的PWD有行为或心理障碍，其中40%是攻击性行为。攻击行为可能是最有问题的干扰，因为它们会导致更多的制度化、伤害和抗精神病药物的使用；然而，对攻击行为的干预措施很少。迫切需要创新的预防方法来取代镇静药物的使用，因为这些药物增加了PWD的死亡率和发病率。PWD中疼痛的患病率约为60%，它是攻击性的强烈预测因素。疼痛的生物-心理-社会模型假设疼痛与心理因素(即抑郁)和社会支持因素(即， 照顾者/残障关系的质量)除了生物因素。因此，抑郁和照顾者/PWD关系的质量可以被视为与疼痛相关的特征。护理者非常适合帮助解决疼痛、抑郁和护理者/PWD的关系，从而防止攻击性的发展；但他们需要工具来帮助他们识别和管理这些症状。该建议的目的是评估这种照顾者干预措施，即对痴呆症患者的照顾者进行攻击预防培训(APT)，1)减少攻击行为的发生，2)减少与攻击相关的结果(养老院安置、照顾者负担、照顾者的积极方面，以及行为问题)，3)减少疼痛和疼痛相关特征(抑郁、照顾者/PWD关系困难)。这项基于未满足需求模型的为期5年的随机对照试验将通过为照顾者提供有针对性的教育和技能培训，重点预防具有疼痛和疼痛相关特征的PWD的攻击性。PWD和他们的照顾者将被随机分配到APT或增强型普通初级保健条件(EU-PC)。APT将使用积极的学习工具，包括教学、角色扮演和多媒体(如书籍和DVD)，为照顾者提供教育和技能培训。干预中的6-8个模块将包括4个核心模块，解决4个主要攻击风险因素：a)识别疼痛，b)治疗疼痛，c)增加愉快的活动，以及d)改善患者与护理者的沟通。护理者可以选择2到3个额外的选修课；选修课的选择是根据双胞胎的需求来进一步提高与这些核心主题相关的技能。EU-PC为患者和照顾者提供有关疼痛的教育材料，通知初级保健提供者PWD的疼痛和抑郁程度，并每周向照顾者提供8次支持性电话。将在基线、3个月、6个月和12个月收集PWD和照顾者的结果。数据分析将包括单变量描述性统计和 推断统计学，包括回归模型、重复测量模型和COX比例风险模型。

DESCRIPTION (provided by applicant): Caregivers of persons with dementia (PWD) are often responsible for their loved one's daily care coordination and provision. Eighty percent of PWD have behavioral or psychological disturbances, including 40% that are aggressive behaviors. Aggressive behaviors are perhaps the most problematic disturbances because they lead to increased institutionalization, injuries, and use of antipsychotic medications; yet few interventions for aggressive behavior are available. Innovative preventive approaches are urgently needed to replace the use of tranquilizing medications because of their associated increased mortality and morbidity in PWD. The prevalence of pain in PWD is about 60%, and it is a strong predictor of aggression. The biopsychosocial model of pain posits that pain is bidirectionally related to psychological factors (ie, depression) and social support factors (i.e., quality of caregiver/PWD relationship) in addition to biological factors. Thus, depression and quality of the caregiver/PWD relationship can be seen as pain-related features. Caregivers are ideally suited to help address pain, depression, and the caregiver/PWD relationship, thus preventing the development of aggression; but they need tools to assist them in identifying and managing these symptoms. The objectives of this proposal are to assess whether this caregiver intervention, Aggression Prevention Training for Caregivers of Individuals with Dementia (APT), 1) decreases incidence of aggression, 2) decreases aggression-related outcomes (nursing-home placement, caregiver burden, positive aspects of caregiving, and behavior problems), and 3) decreases pain and pain-related features (depression, caregiver/PWD relationship difficulties). This 5-year randomized controlled trial based on the Unmet Needs Model will focus on preventing aggression in PWD with pain and pain-related features by providing the caregiver with targeted education and skill training. PWD and their caregivers will be randomized to APT or to an enhanced usual primary care condition (EU-PC). APT will use active learning tools, including didactics, role- playing, and multimedia (eg, books and DVDs) to educate and provide skill training for the caregiver. The 6-8 modules in the intervention will include 4 core modules that address 4 main aggression risk factors: a) recognizing pain, b) treating pain, c) increasing pleasant activities, and d) improving patient-caregiver communication. Caregivers can select 2 to 3 additional elective sessions; elective selection is guided by the needs of the dyad to further enhance skills related to these core topics. EU-PC provides the patient and caregiver educational materials on pain, notifies the primary care provider of the PWD's level of pain and depression, and provides 8 weekly supportive telephone calls to caregivers. PWD and caregiver outcomes will be collected at baseline, 3, 6 and 12 months. Data analysis will include both univariate descriptive statistics and inferential statistics, including regression models, repeated measure modeling and Cox proportional hazards models.