BEHAVIORAL CASE MANAGEMENT FOR ALZHEIMER'S DISEASE CAREGIVERS

理论模型和实证研究表明， 不断增加的压力使家庭面临更高的风险， 在心理、社会和文化等领域的负担和福祉较差， 身体健康结果。对文献的回顾表明， 痴呆症照顾者的身心健康似乎 特别是由于（1）缺乏照顾者的社会支持和（2） 挑战患者的问题行为，包括脱离接触， 行为过度，如流浪，和行为缺陷， 难以进行基本和工具性日常生活活动 (ADLs/IADL）。先前的护理人员干预研究表明， 支持团体，照顾者社会支持和行为管理， 可以对照顾者的精神和身体产生积极的影响， 发病率然而，可以预见的是， 涉及综合治疗成分， 消除压力源。治疗效果似乎有所提高 当治疗是个性化的照顾者的需要和交付 通过面对面和电话联系。 我们建议进行行为案例管理（BCM）干预 包括以患者为中心的干预计划， 脱离接触和问题行为，也是一个以自我为中心的 干预计划，以提高照顾者的社会的积极影响， 支持.本研究的目的1是评估这些药物的效果 通过使用一个关于护理人员福祉的干预方案， 一整套措施。我们所采用的具体的培训计划 是基于一个完善的压力过程模型和经过验证的行为 痴呆症护理的方法。研究的目的2是评估 对痴呆症患者的行为进行干预， 病人自己。我们希望调查这些计划的影响 行为缺陷（ADL/ADL），行为过度， 破坏性定位和患者抑郁。研究的目标3是 促进特定类型的积极影响（工具和 情感）和领域（社会网络和满意度）的社会 支持和研究他们对照顾者结果的影响。评价和 应对技能将被教授，以增加照顾者的接受， 满意的支持。将实施紧急干预措施， 通过一系列战略性的家庭和电话 与看护者/患者二元体的接触。的影响。 干预将与基于电话的最小干预进行比较。 电话支持（MTS）。

Theoretical models and empirical studies of caregiving suggest that caregiving stressors place families at increased risk for high levels of burden and poorer well-being in such areas as psychological, social, and physical health outcomes. A review of the literature indicates that dementia caregivers' physical and psychological well-being appear to be compromised specifically by (1) lack of caregiver social support and (2) challenging patient problem behaviors, including disengagement, behavioral excesses such as wandering, and behavioral deficits such as difficulty performing basic and instrumental activities of daily living (ADLs/IADLs). Previous caregiver intervention studies suggest that support groups, caregiver social support, and behavior management each can have a positive impact on caregivers' psychiatric and physical morbidity. Predictably, however, the most effective interventions involve comprehensive treatment components that address multiple caregiving stressors. Treatment effectiveness appears to be enhanced when treatment is individualized to the caregiver's needs and delivered via face-to-face and telephone contacts. We propose to conduct a Behavioral Case Management (BCM) intervention consisting both patient-focused intervention programs to address patient disengagement and problems behaviors, and also a caregiver-focused intervention program to enhance the positive impact of caregiver social support. Aim 1 of the study is to evaluate the effects of the BCM's intervention programs on caregiver well-being through the use of a comprehensive set of measures. The specific BCM programs that we employ are based on a well-developed stress process model and proven behavioral approaches to dementia care. Aim 2 of the study is to assess the effects of the BCM intervention programs on the behaviors of the dementia patients themselves. We wish to investigate the impact of the programs on behavioral deficits (ADLs/ADLs), behavioral excesses such as disruptive localization, and patient depression. Aim 3 of the study is to foster the positive impact of specific types (instrumental and affective) and domains (social network and satisfaction) of social support and study their influence on caregiver outcomes. Appraisal and coping skills will be taught to increase caregivers acceptance of and satisfaction with support. The BCM intervention will be implemented through a series of strategically sequenced in-home and telephone-based contacts with the caregiver/patient dyad. The effects of the BCM intervention will be compared with those of a telephone-based Minimal Telephone Support (MTS).