Preventing Aggression in Veterans with Dementia

6.项目摘要/摘要 项目背景/基本原理 痴呆症是退伍军人管理局最昂贵的慢性疾病之一。1 2008年，175,621名退伍军人病患患有痴呆症 尽管痴呆症的定义主要是以下几个方面，但2017.1年痴呆症的患病率将增至218,017 记忆障碍、许多经济和社会心理成本都与其频繁并发有关 医学障碍和心理/行为障碍。2008年痴呆症指导委员会 建议VHA资助更多关于非药物干预的研究，以解决行为 80%的痴呆症患者会出现精神障碍。这项研究的调查人员有一个持续的 科学发现的记录，表明迫切需要新的方法来解决侵略问题，这 在40%患有痴呆症的退伍军人中发生，而且经常得不到解决，2导致更多的制度化， 伤害和使用抗精神病药物。3最近完成的HSR&D IIR补助金4(IIR 01-159-2)， “痴呆症患者攻击性的原因和后果”发现，疼痛是 侵袭性的最强预测因素。5已知痴呆症患者的疼痛患病率约为 50%。6 项目目标/目的 迫切需要创新的方法来取代以镇静来对待攻击的模式 药物。没有一种药物能有效地治疗有攻击性的 痴呆症。然而，抗精神病药物是常见的处方药，尽管疗效有限，而且“黑-黑”。 Box“警告与这些药物相关的死亡率和发病率增加的人 痴呆症。我们开发了一种创新的心理教育干预措施，旨在防止 伴有疼痛的痴呆症患者攻击性的发展，并由以下方面的经验证据指导 具有攻击性的可变风险因素。因此，这项提案的目标是评估这一点 干预，预防痴呆症退伍军人的攻击(铺路)，1)减少 攻击性；2)减少疼痛和抑郁；3)减轻照顾者负担，改善照顾者- 患者关系；4)增加愉快的事件；5)减少伤害，抗精神病药物的使用， 和养老院使用。 项目方法 建议的项目是一项随机对照试验，以家庭为基础，为期6-8个疗程 心理教育，照顾者/病人干预。我们将招募220名DYAD(轻度至中度患者 在初级保健诊所接受护理的痴呆症和疼痛患者和主要照顾者)。双星将会是 随机分为铺路干预组或强化普通初级保健组(EU-PC)。铺装用途 教学、角色扮演和多媒体(例如，书籍和DVD)。6-8模块将包括4个核心模块 这涉及到认识和治疗疼痛，增加愉快的活动，并改善患者护理人员 沟通。根据双胞胎的需要选择两到四个额外的选修课，进一步 增强与这些核心主题相关的技能。欧盟-PC将包括为患者和照顾者提供 关于痴呆症和疼痛的教育材料，通知初级保健提供者病人的疼痛程度， 每周给照顾者打8个支持性电话。铺路小组还将获得所有欧盟-PC 组件。

6. PROJECT SUMMARY/ABSTRACT Project Background/Rationale Dementia is one of the most costly chronic conditions in the VA.1 In 2008, 175,621 VA patients had a dementia diagnosis; and the prevalence will increase to 218,017 in 2017.1 Although dementia is primarily defined by memory disturbances, many financial and psychosocial costs are associated with its frequent concurrent medical disorders and psychological/behavioral disturbances. The 2008 Dementia Steering Committee recommended that the VHA fund more research on nonpharmacologic interventions to address behavioral disturbances that occur in 80% of persons with dementia. The investigators of this study have a sustained record of scientific findings that point to the urgent need for new approaches to address aggression, which occurs in 40% of Veterans with dementia and often is not addressed,2 leading to increased institutionalization, injuries, and use of antipsychotic medications.3 A recently completed HSR&D IIR grant4 (IIR 01-159-2), "Causes and Consequences of Aggression in Persons with Dementia," found that pain was among the strongest predictors of aggression.5 The prevalence of pain in persons with dementia is known to be about 50%.6 Project Objectives/Aims Innovative approaches are urgently needed to replace the model of treating aggression with tranquilizing medications. No medications are more than modestly efficacious for treating aggression in persons with dementia. However, antipsychotic medications are commonly prescribed, despite limited efficacy and "black- box" warnings of the increased mortality and morbidity associated with these medications in persons with dementia. We have developed an innovative, psychoeducational intervention that aims to prevent the development of aggression in dementia patients with pain and is guided by empirical evidence regarding mutable risk factors for aggression. As such, the objectives of this proposal are to assess whether this intervention, Preventing Aggression in Veterans with Dementia (PAVeD), 1) decreases incidence of aggression; 2) decreases pain and depression; 3) decreases caregiver burden and improves the caregiver- patient relationship; 4) increases pleasant events; and 5) decreases injuries, use of antipsychotic medication, and nursing-home use. Project Methods The proposed project is a randomized, controlled trial of PAVeD, a 6-8 session, home-based psychoeducational, caregiver/patient intervention. We will recruit 220 dyads (patients with mild-to-moderate dementia and pain who receive care in primary care clinics, and a primary caregiver). Dyads will be randomized to the PAVeD intervention or to an enhanced usual primary care condition (EU-PC). PAVeD uses didactics, role-playing, and multimedia (e.g., books and DVDs). The 6-8 modules will include 4 core modules that address recognizing and treating pain, increasing pleasant activities, and improving patient-caregiver communication. Two to 4 additional elective sessions, selected according to the needs of the dyad, further enhance skills related to these core topics. The EU-PC will include providing the patient and caregiver educational materials on dementia and pain, notifying the primary care provider of the patient's level of pain, and 8 weekly supportive telephone calls to caregivers. The PAVeD group will also receive all EU-PC components.