OPTIMIZING DEMENTIA OUTCOMES IN THE COMMUNITY

描述 优化社区预期影响中的痴呆症结果：该职业发展提案的目标是获得支持以康复为重点的研究议程所需的知识，技能和经验，该议程将建立最佳干预措施，以促进功能，治疗痛苦指标，并保持有意义的人际交往，影响早期和中度痴呆症患者的生活质量和基本日常生活活动。 痴呆的阶段。拟议工作的主要目的是了解认知受损的退伍军人人口在农村环境中的未满足的需求的范围，并确定最佳的二元（退伍军人/照顾者）的干预方法。将开发一个基于电话的康复干预试点。这项工作的影响将实现时，一个有效的和高度可及的康复干预，如电话为基础的心理教育干预试点，成为可用。背景：在美国，超过540万人被诊断患有相关的痴呆症。确定最佳的基于社区的干预措施，以维持退伍军人在家里，而不是住院设施应该在痴呆症规划战略的最前沿。传统的心理社会和心理教育干预措施，目标是提高照顾者的技能和应对需要配对以患者为中心的康复为重点的模块，为个人与早期和中度阶段的痴呆症，以促进最佳功能，将影响生活质量，通过增加身体独立性，社会参与，减少疼痛/痛苦，并保持能力和身份到后期的疾病。然而，现有的基于技能的干预措施采取了非此即彼的方法-侧重于痴呆症患者或提供护理的家庭成员的需求。然而，这些人的社会，身体，医疗和心理健康需求往往是密切相关的，这些人之间的健康关系对于尽可能长时间地保持家庭护理至关重要。最近的一项证据综合得出结论，以患者为中心的多组分干预措施对二分体的需求敏感，最有希望对不同的结果产生影响。居住在农村的退伍军人特别有可能得不到承认，在获得资源方面受到限制。目的：1）对生活在农村地区的退伍军人及其家人进行定性访谈，并在认知屏幕上被确定为经历认知缺陷，以确定他们在VA康复和医疗保健支持方面的感知需求和差距，因为它适用于认知功能和康复; 2）修改一项名为预防痴呆症退伍军人攻击性的循证心理社会干预措施，与退伍军人及其护理人员一起使用，以检查通过电话而不是像最初设计的那样亲自对痴呆症患者及其家庭支持进行这种干预的可行性和必要的基础设施。我们预计，这一修改将增加农村退伍军人群体对痴呆症护理的利用和获得。Hilgeman博士计划在以下领域的资深VA研究人员的指导下获得额外培训：1）痴呆症; 2）混合方法干预开发和临床试验设计; 3）康复科学和干预措施;以及4）农村卫生和远程医疗技术。主要成果将是从与退伍军人的访谈中产生的关于感知需求的定性主题，以及初步的定量和定性数据，这些数据涉及修改后的基于电话的干预的可行性和可能的结果。

DESCRIPTION Optimizing Dementia Outcomes in the Community Anticipated Impacts: This goal of this career development proposal is to acquire the knowledge, skills and experience necessary to champion a rehabilitation-focused research agenda that will establish optimal interventions for promoting functioning, treating indicators of distress, and maintaining meaningful interpersonal engagement that impacts quality of life and basic daily living activities in the early and moderate stages of dementia. A primary aim of the proposed work is to understand the scope of the unmet needs of a cognitively impaired veteran population in a rural setting and to identify optimal dyadic (veteran/caregiver) approaches for intervention. A pilot telephone-based rehabilitative intervention will be developed. The impact of this work will be realized when an efficacious and highly-accessible rehabilitation intervention, such as the telephone-based psychoeducational intervention being piloted, becomes available. Background: Over 5.4 million individuals in the US are diagnosed with related dementing disorders. Determining optimal community-based interventions to maintain veterans at home rather than inpatient facilities should be at the forefront of dementia planning strategies. Traditional psychosocial and psychoeducational interventions that target increasing caregiver skills and coping need to be paired with patient-centered rehabilitation-focused modules for the individuals with early and moderate stages of dementia to promote optimal functioning that will impact quality of life through increased physical independence, social engagement, reduced pain/distress, and maintenance of abilities and identity into the later stages of the disease. Yet, existing skill-basd interventions take an either/or approach - focusing on the needs of either the individual with dementia or the family member who is providing care. Yet, the social, physical, medical, and mental health needs of these individuals are often intimately linked, and a healthy relationship between these individuals is essential for maintaining care in the home for as long as possible. A recent evidence synthesis concluded that patient-centered multi-component interventions sensitive to the needs of the dyad offer the most promise for effects on diverse outcomes. At particular risk of under recognition and limitations in access to resources are rural-residing veterans. Objectives: 1) To conduct qualitative interviews with veterans and their families who live in rural areas and have been identified on a cognitive screen as experiencing cognitive deficits to determine their perceived needs and gaps in VA rehabilitation and health care supports as it applies to cognitive functioning and rehabilitation; and 2) to modify an evidence-based psychosocial intervention called Preventing Aggression in Veterans with Dementia, for use with veterans and their caregivers to examine the feasibility and necessary infrastructure of conducting this intervention with individuals with dementia and their family support by phone rather than in person as it was originally designed. We anticipate that this modification will increase utilization and access to dementia care in rural veteran populations. Dr. Hilgeman plans to obtain additional training under the mentorship of well-established VA researchers in the following areas: 1) dementia; 2) mixed-methods intervention development and clinical trial design; 3) rehabilitation science and interventions; and 4) rural health and telemedicine technologies. The primary outcomes will be qualitative themes generated from interviews with veterans about perceived needs as well as preliminary quantitative and qualitative data addressing the feasibility and likely outcomes of the modified phone-based intervention.