Apathy in Nursing Home Residents with Dementia: Impact of Caregiver Communication

摘要 冷漠是一种症状，表现为缺乏动力，目标导向行为减少，以及 对环境刺激的反应能力强，情绪平和。近50%的养老院(NH)居民 患有阿尔茨海默病和相关痴呆(ADRD)和84%患有ADRD的NH居民表现出 冷漠。冷漠是一个重要的问题，因为它与相当大的负面结果有关， 包括认知和功能衰退加速，生活质量下降，疾病结局更差， 需要机构护理，以及更高的死亡率。护理者与居民之间的沟通是日常护理的基础 在国民健康保险制度中的活动，并对护理质量产生重大影响。与患有ADRD的居民互动可以是 挑战性，因为他们在理解、记忆和口头表达方面存在困难。 与患有ADRD和冷漠的居民互动尤其具有挑战性，因为他们是社交 沉默寡言，不主动，依赖他人的提示进行互动。旨在改善的干预措施 护理者沟通和以人为中心的活动已被证明可以减少一些行为 ADRD的症状。目前还不清楚同一个人的冷漠症状随着时间的推移会有多大的不同 并跨越不同的个体。这些信息将有助于澄清冷漠可能达到的潜在程度 变化。这项拟议的研究将通过分析大小和持续时间的变化来解决这一差距 个人内部和个人之间的冷漠症状。此外，照顾者的沟通如何影响尚不清楚 冷漠。因此，这项研究将考察照顾者沟通对冷漠的影响。这是一个次要的 使用NIH资助的一项已完成临床试验的现有视频数据进行分析。数据集包括视频 12个NHS的46名居民在照顾者与居民互动过程中的观察。录像带是在 在5-9个月的多个时间点进行常规护理活动。这项研究的目的是检查不同类型的 冷漠症状的大小和持续时间，并检查同时和顺序关系 在照顾者沟通和冷漠症状之间。首先，我们将测试冷漠模式的变化 居民，跨交互的同一居民内，以及每个交互内。接下来，我们将分析四个 护理者沟通素质的几个方面：1)沟通话题，2)情感基调，3)以人为本 言语交际；4)以人为中心的非言语交际。我们预计会以人为中心 沟通方式将与较低水平的冷漠症状相关。这是第一次研究 研究照顾者沟通对冷漠的影响。调查结果将有助于确定改进的方法 照顾者沟通，可用于制定干预措施，以减少冷漠，改善居民 健康结果、生活质量，并降低患有ADRD的NH居民的死亡率。这项研究将有助于促进 为ADRD服务提质增效实现2017年国家计划主要目标 阿尔茨海默氏症。

ABSTRACT Apathy is a symptom that presents with a deficit of motivation, reduced goal-directed behaviors and responsiveness to environmental stimulation, and a flat mood. Nearly 50% of nursing home (NH) residents live with Alzheimer’s disease and related dementias (ADRD) and 84% of NH residents with ADRD demonstrate apathy. Apathy is a significant problem because it is associated with considerable negative outcomes, including accelerated cognitive and functional decline, lower quality of life, poorer illness outcomes, greater need for institutional care, and higher mortality. Caregiver-resident communication is fundamental for daily care activities in NHs and significantly impacts quality of care. Interacting with residents with ADRD can be challenging, due to their difficulty in understanding, remembering, and verbally expressing themselves. Interacting with residents with ADRD and apathy is especially challenging, because they are socially withdrawn, do not take initiative, and rely on others’ prompts to engage in interactions. Interventions to improve caregiver communication and person-centered activities have been shown to reduce some behavioral symptoms in ADRD. It is unclear to what extent that apathy symptoms differ over time for the same individual and across different individuals. This information will help to clarify the potential extent to which apathy can be changed. This proposed study will address this gap by analyzing variations in the magnitude and duration of apathy symptoms within and between individuals. Further, it is unknown how caregiver communication impacts apathy. Thus, this study will examine the impact of caregiver communication on apathy. This is a secondary analysis using existing video data from a completed NIH-funded clinical trial. The dataset comprises video observations from 46 residents during caregiver-resident interactions in 12 NHs. Videos were recorded during routine care activities at multiple time points over 5-9 months. This study aims to examine variations in the magnitude and duration of apathy symptoms and examine the concurrent and sequential relationships between caregiver communication and apathy symptoms. First, we will test variations of apathy pattern across residents, within the same resident across interactions, and within each interaction. Next, we will analyze four aspects of caregiver communication qualities: 1) communication topic, 2) emotional tone, 3) person-centered verbal communication, and 4) person-centered non-verbal communication. We anticipate that person-centered communication approaches will be associated with lower levels of apathy symptoms. This is the first study examining the impact of caregiver communication on apathy. Findings will help identify approaches to improve caregiver communication, which can be used to develop interventions to reduce apathy, improve resident health outcomes, quality of life, and reduce mortality for NH residents with ADRD. This study will help promote care quality and efficiency for ADRD and achieve the major goal of the 2017 National Plan to Address Alzheimer’s Disease.