Preparing for future dementia care: A study of hospitalized patient-family dyads

为未来的痴呆症护理做准备：住院患者与家庭二人组的研究

基本信息

批准号：
8876407
负责人：
Lyndsey Medora Miller
金额：
$ 4.31万
依托单位：
OREGON HEALTH & SCIENCE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-07-01 至 2016-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8876407
关键词：
Acute Advocate Affect Alzheimer&apos s Disease Caregivers Caring Cessation of life Cognitive Collaborations Communities Complex Cross-Sectional Studies Data Decision Making Dementia Development Diagnosis Disease Elderly Ensure Equilibrium Family Family Caregiver Frequencies Frontotemporal Dementia Future Goals Health Hospitalization Hospitals Impaired cognition Individual Intervention Intervention Studies Knowledge Lewy Body Dementia Life Mental Depression Methods National Research Service Awards Neurologic Nurses Outcome Patients Perception Persons Physical Function Preparation Process Provider Regression Analysis Research Research Personnel Research Training Risk Risk Factors Scientist Syndrome Time Training United States Vascular Dementia caregiving cognitive ability community setting design end of life executive function improved information processing innovation insight multilevel analysis next generation preference pressure public health relevance substituted judgment

项目摘要

DESCRIPTION (provided by applicant): Hospitalizations occur three times as often for persons with dementia (PWDs) as for older adults in general. Prior to hospital discharge, important decisions must be made about the PWD's future care. Although PWDs can provide consistent and reliable information, the process of preparing for future care requires additional cognitive abilities including executive function and insight, which decline in dementia. Hospital providers rely upon family caregivers to advocate for the care values of and make surrogate decisions for the PWD, even when PWDs want to participate in their own care planning. Thus, it is important for family caregivers to be congruent with PWDs regarding their care values in order to make decisions that are aligned with the PWD's preferences for future care. The overall goal of this study is to identify PWD-caregiver dyads most at risk of incongruence while in the midst of a health crisis and looming decisions about future dementia care. A descriptive cross-sectional study of 60 dyads will be conducted in the acute care setting. The aims of this study are: 1) To identify the modifiable variables associated with incongruence in PWD and caregiver perceptions of the PWD's care values; 2) To explore the relationship between incongruence in perceptions of the PWD's care values and the caregiver's preparation for future care. Data will be collected from both the PWD and caregiver. Incongruence will be analyzed at the level of the dyad using multilevel modeling. The relationship between preparation for future care and incongruence in perceptions of the PWD's care values will be examined using multiple regression analysis. This study pertains to NINR's focus on research that promotes decision-making for complex treatment and care options in the face of life-threatening illness, including end-of-life care. In addition, as part of an NRSA proposal, this study contributes to the applicant's long-term goal of developing into an independent nurse researcher who is successful in implementing targeted interventions that improve dementia care planning by balancing the needs of family caregivers and the care values of the PWD. In order to ensure that the applicant has the necessary knowledge and expertise to attain this goal, the training plan draws upon the combined expertise of an interdisciplinary team consisting of researchers who are experts in family caregiving, dementia, analytic methods for dyadic data, and hospitalized patients with cognitive impairment. In collaboration with the applicant, the expert team has developed a comprehensive training plan that includes mastery of content related to dementia care values, expertise in multiple analytic approaches, understanding of intervention research, and dissemination. The research and training outcomes of this proposal are aligned with the goals of the NINR, in that it will support the development of the next generation of nurse scientists, enhance innovation, and contribute to the improvement of the care planning process for PWDs and caregivers.

描述（由申请人提供）：痴呆症患者（PWDS）的住院次数是通常的老年人的三倍。在出院之前，必须对PWD的未来护理做出重要决定。尽管PWD可以提供一致且可靠的信息，但是为将来的护理做准备的过程需要额外的认知能力，包括执行功能和洞察力，而痴呆症的下降。医院提供者依靠家庭护理人员来倡导PWD的护理价值，并为PWD做出代孕决定，即使PWD希望参加自己的护理计划。因此，对于家庭护理人员来说，重要的是要与PWD有关其护理价值，以便做出与PWD对未来护理的偏好保持一致的决定。这项研究的总体目标是确定PWD医生二元组最有不一致的风险，而在健康危机和关于未来痴呆症护理的迫在眉睫的决定中。在急性护理环境中将对60个二元组进行描述性横断面研究。这项研究的目的是：1）确定与PWD和护理人员对PWD护理值的看法相关的可修改变量； 2）探索对PWD护理价值观的看法与看护人为未来护理的准备之间的关系。数据将从PWD和护理人员中收集。使用多级建模将在Dyad的水平上分析不一致。将使用多元回归分析来检查对未来护理的准备与对PWD护理值的不一致之间的关系。这项研究涉及Ninr对研究的研究，该研究促进了面对威胁生命的疾病（包括寿命终止护理）的复杂治疗和护理选择的决策。此外，作为NRSA建议的一部分，这项研究为申请人的长期目标做出了贡献，即成功地将其发展为独立的护士研究人员，他们成功地实施了有针对性的干预措施，从而通过平衡家庭护理人员的需求和PWD的护理价值来改善痴呆症护理计划。为了确保申请人具有实现这一目标的必要知识和专业知识，培训计划借鉴了由研究人员组成的跨学科团队的综合知识，这些研究人员是家庭护理，痴呆症，二氧化数据的分析方法的专家，以及住院的患者认知障碍。专家团队与申请人合作制定了一项全面的培训计划，其中包括掌握与痴呆症护理价值有关的内容，多种分析方法的专业知识，对干预研究的理解和传播。该提案的研究和培训成果与NINR的目标保持一致，因为它将支持下一代护士的发展科学家，增强创新，并为改善PWD和看护人的护理计划过程做出贡献。