CommunityRx-Dementia

项目摘要/摘要 超过1600万名无偿照顾者照顾着迅速增长的居家人口，这些人 美国的阿尔茨海默病和相关痴呆(ADRD)。ADRD照顾者的身体健康状况较差 比他们的同龄人高，负担和抑郁的比率很高。耻辱和社会孤立很常见。联邦法律 呼吁将照顾者与社区资源联系起来(例如，ADRD教育、支持团体、暂缓护理)， 特别关注缩小健康差距。同时，CMS正在测试常规评估和转介 用于未得到满足的与健康相关的社会需求(如食品、住房、人际安全和社会支持)。 照看的需求通常会产生经济压力，但在这群人中，人力资源信托基金仍然被忽视。低 需要密集、可扩展的资源转介解决方案来管理和促进 所有ADRD照顾者和痴呆症患者(PWD)。这项拟议的研究，在一个以非洲人为主的 芝加哥南部的美国/黑人人口，将填补关于如何最好地干预的知识空白 支持ADRD照顾者。我们将进行一项随机对照疗效试验，以测试 社区-痴呆症(CRX-D)干预对照顾者和照顾者12个月的结果。CRX- D建立在社区Rx的基础上，这是一种基于信息的干预，系统地将人们与附近的人进行匹配 社区资源，以满足HRSNs、护理和其他自我照顾需求。照顾者将根据未满足的情况进行分层 HRSNs和随机分为常规护理或常规护理+CRX-D。在初级保健访问期间，照顾者分配了 到CRX-D将收到：(A)关于ADRD照顾者共同资源需求的信息，使之正常化 这些需求；(B)个性化资源“处方”(HealtheRx-D)；(C)使用在线 社区资源寻求者；以及(D)关于如何激活社区资源的指导，包括如何到达 CRX-D社区资源专家。CRX-D小组还将在8周内收到短信，提供 激活资源的其他支持。这项研究的具体目的是(1)在有以下情况的照顾者中 未满足的HRSNs，评估CRX-D与常规护理对照顾者自我效能和继发性护理的影响 心理社会和行为结果，以及健康和保健利用；(2)评估 CRX-D与常规护理对包括满意度在内的健康护理体验的干预和影响 有了护理，临床护理期间的耻辱经历和共享社区资源信息的可能性 与其他人；(3)定性评估照顾者的：CRX-D干预的经验；耻辱在 披露需求和访问资源；以及与他人共享资源信息的体验。我们的 目标是通过在照顾者自己的角度与照顾者进行干预来促进照顾者的健康和福祉 初级医疗保健。这项研究的长期目标是促进公共健康，减轻 越来越多的ADRD照顾者和残障人士。这项工作通过产生新的 关于促进ADRD照护成果和支持的社区资源联系的知识。

PROJECT SUMMARY/ABSTRACT More than 16 million unpaid caregivers care for a rapidly growing population of home-dwelling people with Alzheimer’s disease and related dementias (ADRD) in the US. ADRD caregivers have poorer physical health than their peers and high rates of burden and depression. Stigma and social isolation are common. Federal law calls for connecting caregivers to community resources (e.g. ADRD education, support groups, respite care), with special concern for reducing health disparities. In parallel, CMS is testing routine assessment and referral for unmet health-related social needs (HRSNs) (e.g. food, housing, interpersonal safety and social support). Demands of caregiving commonly produce financial strain, yet HRSNs remain overlooked in this population. Low intensity, scalable resource referral solutions are needed to manage and promote the health and well-being of all ADRD caregivers and persons with dementia (PWD). The proposed research, in a predominantly African American/Black population on Chicago’s South Side, will fill a gap in knowledge about how to best intervene to support ADRD caregivers. We will conduct a randomized, controlled efficacy trial to test the effect of the CommunityRx-Dementia (CRx-D) intervention on caregiver and care recipient outcomes over 12 months. CRx- D builds on CommunityRx, an information-based intervention that systematically matches people to nearby community resources for HRSNs, caregiving and other self-care needs. Caregivers will be stratified by unmet HRSNs and randomized to usual care or usual care + CRx-D. During a primary care visit, caregivers assigned to CRx-D will receive: (a) information about common resource needs among ADRD caregivers, to normalize these needs; (b) a personalized resource "prescription" (HealtheRx-D); (c) demonstration on use of an online Community Resource Finder; and (d) coaching on how to activate community resources, including how to reach the CRx-D community resource specialist. The CRx-D group will also receive texts over 8 weeks offering additional support to activate resources. The specific aims of this research are to (1) Among caregivers with unmet HRSNs, evaluate the effects of CRx-D versus usual care on caregiver self-efficacy and secondary psychosocial and behavioral outcomes, as well as health and healthcare utilization; (2) Evaluate acceptability of the intervention and the effects of CRx-D versus usual care on the health care experience, including satisfaction with care, experiences of stigma during clinical care and likelihood of sharing community resource information with others; (3) Qualitatively assess caregivers’: experiences with the CRx-D intervention; the role of stigma in disclosing needs and accessing resources; and experiences sharing resource information with others. Our objective is to promote caregiver health and well-being by intervening with caregivers at the point of their own primary healthcare. The long-term goal of this research is to promote public health and alleviate suffering among a growing population of ADRD caregivers and PWD. This work advances the mission of NIA by generating new knowledge about community resource connections that promote ADRD caregiving outcomes and supports.