Assessing preferences for everyday living in the nursing home: reliability and co

描述（由申请人提供）：长期护理的当前趋势，与CMS生活质量指南相一致，要求将重点转向“以人为本的护理”。疗养院（NH）中最佳护理的不断发展的概念强调需要“了解人”，以便提供个性化的整体护理。然而，将老年人的观点作为塑造护理服务的核心组成部分，取决于拥有一个全面和可靠的工具，可以有效地收集这些信息。目前还没有这样的评估工具。了解居民的日常生活偏好是进行个体化护理计划的基础。尽管这种中心性，护理偏好的可靠性尚未在NH样本中进行评估。本研究的目的是开发一种综合的评估工具，该工具包含新罕布什尔州居民对他们最重要的偏好项目的看法，评估随时间推移的偏好反应的可靠性，并检查居民偏好变化的预测因素。在第一阶段（n=80），本研究将使用认知访谈技术来调整最初为社区居住老年人设计的日常生活偏好清单（PELI），以确保其适用于NHs的体弱居民，包括轻度至中度认知障碍的居民。另外，第一阶段将对仪器一周的可靠性进行测试，剔除不可靠项目。使用这个新调整的工具，第二阶段（n=300）将解决哪些偏好对居民最重要和最不重要，以及三个月期间NH居民偏好的可靠性。多元回归和逻辑回归以及结构方程模型将用于检验偏好反应的可靠性与本研究小组和文献中提出的假设预测变量之间的关系。焦点小组参与者（n=40）将使我们能够从居民的角度检查偏好反应变化的来源。我们还将研究与检验家庭代理和居民偏好反应之间的一致性相关的探索性假设。拟议项目的完成将导致提交R01提案，测试PELI嵌入一个干预计划，旨在改善居住在NHs的痴呆症患者的行为和情感障碍。主要的具体目标是：1)使用认知访谈（CI）技术使PELI适应居住在NHs的体弱老年人；检验一周重测信度；剔除不可靠的项目；2)从有和没有认知障碍的NH居民的角度确定日常偏好中最重要和最不重要的领域；3)定量评估3个月期间NH居民偏好反应的可靠性，并检验预测因子与居民偏好反应变化之间的假设关系；4)从居民的角度定性地检验反应信度问题。探索目的：考察居民偏好评价与家庭成员代理评价之间的一致性。

DESCRIPTION (provided by applicant): Current trends in long-term care, in concert with CMS Quality of Life guidelines, call for a shift in focus to "person-centered care". Evolving conceptualizations of optimal care in the nursing home (NH) are emphasize the need to "know the person" in order to deliver individualized, holistic care. However, incorporating the elder's perspective as a central component in shaping care delivery depends on having a comprehensive and reliable instrument that can gather this information effectively. Currently, no such assessment instrument is available. Knowledge of a resident's everyday life preferences is the foundation on which ongoing individualized care planning is based. Despite this centrality, the reliability of preferences for care has not been assessed in a NH sample. The purpose of this study is to develop a comprehensive, assessment instrument that incorporates NH residents' views of what preference items are most important to them, assess the reliability of preference responses over time, and to examine predictors of changes in resident preferences. In Phase 1 (n=80), this study will use cognitive interviewing techniques to adapt the Preference for Everyday Living Inventory (PELI), originally designed for community dwelling elders, to ensure its applicability to frail residents in NHs, including those with mild to moderate cognitive impairment. In addition, Phase 1 will test the one week reliability of the instrument and cull unreliable items. Using this newly adapted instrument, Phase 2 (n=300) will address which preferences are most and least important to residents and the reliability of preferences over a three month period for NH residents. Multivariate and logistic regression, as well as structural equations models will be used to examine relationships between reliability in preference responses and hypothesized predictor variables suggested from preliminary studies by this research team and the literature. Focus group participants (n=40) will enable us to examine sources of changes in preference responses from the resident's perspective. We will also examine exploratory hypotheses related to examine concordance between family proxy and resident preference responses. The completion of the proposed project will lead to the submission of an R01 proposal testing the PELI embedded in an intervention program designed to ameliorate behavioral and affective disturbances in persons with dementia residing in NHs. The primary specific aims are: 1) Adapt PELI to frail elders residing in NHs using cognitive interviewing (CI) techniques; examine one week test-retest reliability; and cull unreliable items; 2) Identify the most and least significant areas of everyday preferences from the perspective of NH residents, both with and without cognitive impairment; 3) Quantitatively assess the reliability of preference responses of NH residents over a 3-month period and test hypothesized relationships between predictors and resident changes in preference responses; and 4) Qualitatively examine response reliability issues from residents' perspective. Exploratory aim: Examine the concordance between resident-rated preferences and family member proxy ratings of resident preferences. PUBLIC HEALTH RELEVANCE: This primary goal of this study is to redesign and test the reliability of a measure of psychosocial preferences for everyday living in a frail nursing home population. Measurement development and reliability determination are necessary first steps in the ultimate goal of using this measure to enhance holistic individualized care to nursing home residents.