Aggression Prevention Training for Caregivers of Persons with Dementia

描述（申请人提供）：照顾失智症人士（PWD）的人通常负责他们所爱的人的日常照顾协调和提供。80%的残疾人有行为或心理障碍，其中40%有攻击性行为。攻击性行为可能是最有问题的障碍，因为它们会导致制度化、伤害和抗精神病药物的使用增加；然而，几乎没有针对攻击行为的干预措施。迫切需要创新的预防方法来取代镇静药物的使用，因为它们与PWD的死亡率和发病率增加有关。疼痛在PWD中的患病率约为60%，它是攻击的一个强有力的预测指标。疼痛的生物-心理-社会模型认为，疼痛与心理因素（如抑郁）和社会支持因素(如：

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.