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

描述（由申请人提供）：痴呆症患者（pwd）住院的频率是一般老年人的三倍。出院前，必须对残疾患者的未来护理作出重要决定。虽然残疾人士可以提供一致和可靠的信息，但为未来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，而这些能力在痴呆症患者中会下降。医院提供者依靠家庭护理人员来倡导残疾人的护理价值，并为残疾人做出替代决定，即使残疾人希望参与自己的护理计划。因此，对于家庭照顾者来说，在照顾价值观上与残疾人士保持一致是很重要的，这样才能做出符合残疾人士对未来照顾偏好的决定。本研究的总体目标是确定在健康危机和对未来痴呆症护理迫在眉睫的决定中，最有可能出现不一致风险的pwd护理者。一个描述性的横断面研究60对将在急性护理设置进行。本研究的目的是：1)确定与残疾人士的不一致性和照顾者对残疾人士护理价值观的认知相关的可修改变量；2)探讨残疾人护理价值观认知不一致与照顾者未来护理准备的关系。我们会向残疾人士及照顾者收集资料。不一致将在使用多层建模的双元水平上进行分析。对未来护理的准备与残疾人士对护理价值的认知不一致之间的关系将采用多元回归分析进行检验。这项研究与NINR的研究重点有关，即在面对危及生命的疾病时，促进复杂治疗和护理选择的决策，包括临终关怀。此外，作为NRSA提案的一部分，本研究有助于申请人的长期目标，即发展成为一名独立的护士研究员，通过平衡家庭照顾者的需求和残疾人的护理价值，成功实施有针对性的干预措施，改善痴呆症护理计划。为了确保申请人具备实现这一目标所需的知识和专业知识，培训计划利用了一个跨学科团队的综合专业知识，该团队由家庭护理、痴呆症、二元数据分析方法和患有认知障碍的住院患者方面的专家组成。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相关的内容，掌握多种分析方法的专业知识，了解干预研究和传播。该提案的研究和培训成果与国家护士研究所的目标一致，因为它将支持下一代护士的发展

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.