A mixed methods observational study of persistent vocalizations in nursing home residents with moderate to severe dementia

中度至重度痴呆疗养院居民持续发声的混合方法观察研究

• 批准号: 9108167
• 负责人: JUSTINE SUZETTE SEFCIK
• 金额: $ 1.67万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2016-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9108167
• 关键词: Acceleration; Achievement; Address; Administrator; Adverse effects; Aggressive behavior; Award; Behavior; Behavioral Symptoms; Caregiver Burden; Characteristics; Clinical; Competence; Complex; Data; Data Sources; Delirium; Dementia; Development; Distress; Early identification; Elderly; Employee; Ensure; Environment; Exhibits; Family; Family member; Formal caregiver; Foundations; Frequencies; Future; Heart Rate; Hunger; Impairment; Individual National Research Service Award; Intervention; Knowledge; Lead; Light; Long-Term Care; Long-Term Care Nursing; Measurement; Measures; Mentors; Methods; Mission; Modeling; National Institute of Nursing Research; National Research Service Awards; Noise; Nurses; Nursing Homes; Nursing Staff; Observational Study; Pain; Participant; Persons; Physical environment; Physiological; Pilot Projects; Positioning Attribute; Prevalence; Quality of life; Reading; Registered nurse; Research; Research Personnel; Research Project Grants; Research Training; Respiration; Risk; Scientist; Sedation procedure; Sensory; Social Environment; Speed; Stress; Stroke; Symptoms; System; Testing; Training; Translating; Video Recording; Vulnerable Populations; Work; base; cognitive function; design; driving behavior; exercise physiologist; exhaustion; experience; improved; informal caregiver; innovation; member; physical state; prevent; programs; psychosocial; public health relevance; response; skills; social; sound; symptom management; therapy development; vocalization

 DESCRIPTION (provided by applicant): The purpose of this individual National Research Service Award (NRSA) application is to provide the applicant with essential research training to become an independent investigator focusing on behavioral symptoms of dementia, more specifically persistent vocalizations (PVs) (otherwise known as disruptive vocalizations or problematic vocalizations). This NRSA will ensure that the applicant achieves competence in the methodological and analytical skills to conduct ethically sound research with the vulnerable population of older adults with dementia. From her clinical experience as a Registered Nurse in nursing homes (NH), the applicant has first-hand knowledge of how distressing PVs are for other residents, staff, and visitors including family members and how PVs decrease the quality of life for the NH resident(s) with PVs themselves. Prevalence rates among NH residents with dementia and PVs are as high as 81%. Without a deeper understanding of the underlying cause of PVs, nursing staff are unable to effectively prevent or manage them. The overall purpose of this innovative, mixed methods research project is to use physiological measures and observational data to describe persons with moderate to severe dementia and PVs. Using the Needs-driven Dementia-compromised Behavior model as a framework, the applicant will examine the proximal factors (physiological and psychosocial needs states, physical environment and social environment factors) that lead to PVs. Having a greater understanding of PVs and their causes can enable the development and testing of tailored interventions to reduce them. This is the first known study to investigate potential physiological indictors prior t, during and after a PV episode. These physiological data will be combined with other source data including qualitative analysis of video recordings and field notes, noise decibel readings and 3 observational measurement scales to characterize the period prior to, during, and after PV episodes. The applicant's research training will be guided by a mentoring team including Dr. Mary Ersek, a well-known researcher in long term care and pain in persons with dementia; Dr. Pamela Cacchione, a sensory impairment, delirium and dementia expert; Dr. Cornelia Beck, an expert on dementia and persons with dementia and PVs; and Dr. Joseph Libonati, an exercise physiologist with expertise in the use of the BioHarness System that will be used to collect physiological data. This research addresses the priority of the National Institute of Nursing Research on symptom management because it proposes to investigate PVs to build the evidence toward successful symptom management of this challenging behavioral symptom of dementia. The specific research and methodological approach proposed in this application has wide applicability to many stakeholders, including formal and informal caregivers, residents with dementia and behavioral symptoms, nursing home administrators and other researchers exploring behavioral symptoms.

 这个个人国家研究服务奖（NRSA）申请的目的是为申请人提供必要的研究培训，使其成为专注于痴呆症行为症状的独立调查员，更具体地说，持续性发声（PV）（也称为破坏性发声或有问题的发声）。该NRSA将确保申请人获得方法和分析技能的能力，以与老年痴呆症患者的弱势群体进行道德上合理的研究。从她的临床经验作为一个注册护士在疗养院（NH），申请人有第一手的知识如何痛苦的肺静脉是其他居民，工作人员和访客，包括家庭成员和肺静脉如何降低生活质量的NH居民（S）与肺静脉本身。NH居民中痴呆和PV的患病率高达81%。如果没有更深入的了解肺静脉的根本原因，护理人员无法有效地预防或管理它们。这个创新的混合方法研究项目的总体目的是使用生理措施和观察数据来描述中度至重度痴呆和PV患者。使用需求驱动的痴呆妥协行为模型作为框架，申请人将检查导致PV的近端因素（生理和心理社会需求状态，物理环境和社会环境因素）。对肺静脉及其原因有更深入的了解，可以制定和测试有针对性的干预措施，以减少肺静脉。这是已知的第一项研究，旨在研究PV发作之前、期间和之后的潜在生理指标。这些生理数据将与其他源数据（包括视频记录和现场记录的定性分析、噪声分贝读数和3个观察测量量表）相结合，以表征PV发作之前、期间和之后的时间段。申请人的研究培训将由一个指导小组指导，包括玛丽埃尔塞克博士，一个著名的长期护理和老年痴呆症患者的疼痛研究员;帕梅拉Cacchione博士，一个感觉障碍，谵妄和老年痴呆症专家;科尔内利亚贝克博士，一个老年痴呆症和老年痴呆症和PV患者的专家;以及约瑟夫·利博纳蒂博士，他是一位运动生理学家，擅长使用生物传感器系统来收集生理数据。这项研究解决了国家护理研究所对症状管理的优先事项，因为它建议调查PV，以建立成功的症状管理的证据，这种具有挑战性的行为症状的痴呆症。本申请中提出的具体研究和方法学方法对许多利益相关者具有广泛的适用性，包括正式和非正式的护理人员，患有痴呆症和行为症状的居民，养老院管理人员和其他探索行为症状的研究人员。