Training to Improve Late-Stage Dementia Care

描述（由申请人提供）：阿尔茨海默氏病和相关痴呆（ADRD）联合收割机形成了21世纪世纪美国老龄化人口面临的紧迫的医疗保健挑战。在美国，2008年，每71秒就有一个人被诊断出ADRD;到2050年，这个数字将是每33秒一个。在本申请报告的正文中引用的当局ADRD是美国第三大最昂贵的疾病集。尽管正在进行研究，但目前没有办法预防ADRD的发作，死亡是唯一确定的治愈方法。护理选择是复杂的，因为晚期ADRD患者的认知和身体下降因人而异，没有单一的护理常规或方案是可预测的有效的。此外，与晚期ADRD护理相关的挑战给注册护理助理（CNA）带来了巨大的压力和增加的负担。许多医疗主任和其他ADRD机构的专业人员往往缺乏准备或时间来回应CNA的请求，帮助管理晚期ADRD患者的护理。然而，在ADRD护理方面经验丰富的各种当局表明，当CNA在这一领域接受持续教育和技能培训时，会产生可衡量的积极效果。因此，第二阶段的努力旨在教育CNA他们需要的知识和技能，以有效地照顾那些在晚期ADRD下降，并通过一个创新的，基于互联网的培训计划，提出10个专题模块小时的挑战，信息，应用为基础的课程。该产品超越了传统的CNA教育和在职培训的被动方法，而是提供多媒体功能，如访谈，护理模型，现实生活中的流媒体视频和在线互动。通过这一培训计划，CNA获得方便，24/7，私人访问整个团队的干预顾问和治疗支持专家在管理晚期ADRD相关的护理经验。改进的CNA实践的分散效果也可能促进多层次的干预，以许多积极的方式影响护理接受者本身及其亲人。除了其强大的商业潜力外，拟议的第二阶段培训产品还能够在长期护理设施，辅助生活设施，社区学院，军队和退伍军人医院和服务，医疗办公室，医疗机构以及农村和城市医疗机构等各种场所造福公共卫生。在第二阶段，一项随机对照试验（RCT）将测试完成的干预措施的有效性，并在第三阶段进行商业化。考虑到申请组织与阿尔茨海默氏症协会国家办公室的合作，这一努力的所有阶段的平行好处之一很可能是减少ADRD对美国医疗保健系统的直接和间接成本。 公共卫生相关性：所提出的努力与国家的公共健康相关，因为在2008年期间，520万所有年龄段的美国人患有阿尔茨海默病和相关痴呆症（ADRD），这转化为每71秒一次ADRD诊断（阿尔茨海默病事实和数据，2008，第8页）。ADRD的经济成本包括Medicare和Medicaid的直接成本1480亿美元（不包括退伍军人事务部、私人医疗保健和长期护理保险支付的费用），据估计，为国家医疗保健系统节省了2670亿美元，因为980万家庭成员在家中为ADRD患者提供了至少70%的护理，而无需报销而不是在养老院此外，晚期ADRD护理与护理人员的心理社会成本密切相关，护理人员必须直接对晚期痴呆症特征性认知下降的居民做出反应（阿尔茨海默病事实和数据，2008）。

DESCRIPTION (provided by applicant): Alzheimer's disease and related dementias (ADRD) combine to form an urgent healthcare challenge facing the aging population of 21st Century America. In the U.S. during 2008, one person received an ADRD diagnosis every 71 seconds; by 2050, that number will be one every 33 seconds. Authorities cited in the body of this application report ADRD are the third most costly disease sets in the U.S. In spite of ongoing research efforts, at present there is no way to prevent onset of ADRD, and death is the only certain cure. Caregiving options are complicated because the cognitive and physical declines of those with late-stage ADRD differ for each person, and no single care routine or protocol is predictably effective. Further, the challenges associated with late-stage ADRD care cause immense stress and increased burden to Certified Nursing Assistants (CNAs). Many medical directors and other ADRD facility professionals often lack either the preparation or the time to respond to CNAs' requests for help in managing patient care with those in late-stage ADRDs. Various authorities experienced in ADRD care, however, suggest measurable positive effects result when CNAs receive ongoing education and skill training in this area. This Phase II effort aims therefore to educate CNAs in the knowledge and skills they need to care effectively for those in late-stage ADRD decline and to do so through an innovative, Internet-based training program presenting 10 topical module hours of challenging, informative, application-based curriculum. This product exceeds traditional passive methods of CNA education and in-service training and provides instead multi-media features such as interviews, care models, real-life streaming videos, and online interaction. Through this training program, CNAs gain convenient, 24/7, private access to an entire team of intervention consultants and therapeutic support specialists experienced in managing late-stage ADRD-related care. The dispersed effects of improved CNA practice may also facilitate a multi-level intervention with power to affect in many positive ways the care recipients themselves as well as their loved ones. In addition to its strong commercial potential, the proposed Phase II training product has the capacity to benefit public health in venues as diverse as long-term care facilities, assisted-living facilities, community colleges, military and veterans' hospitals and services, medical offices, healthcare agencies, and both rural and urban healthcare settings. During Phase II, a randomized controlled trial (RCT) will test efficacy of the completed intervention, and commercialization will be undertaken during Phase III. Given the applicant organization's collaboration with the national office of the Alzheimer's Association, one of the parallel benefits of all phases of this effort may well be the reduction of both direct and indirect costs of ADRD to U.S. health care systems. PUBLIC HEALTH RELEVANCE: The proposed effort is relevant to the nation's public health because during 2008, 5.2 million Americans of all ages have Alzheimer's disease and related dementias (ADRD), which translates to one ADRD diagnosis every 71 seconds (Alzheimer's Disease Facts and Figures, 2008, p. 8). The economic cost of ADRD includes $148 billion in direct costs to Medicare and Medicaid (not including the costs paid for by the Department of Veterans' Affairs, private health care, and long-term care insurance), and an estimated $267 billion savings to the national healthcare system because 9.8 million family members deliver at least 70 percent of the care for those with ADRD at home without reimbursement instead of in nursing homes. Further, late-stage ADRD care is strongly associated with psychosocial costs to caregivers, who must respond directly to residents in the cognitive declines characteristic of late-stage dementia (Alzheimer's Disease Facts and Figures, 2008).