Promoting Reengagement in Daily Meaningful Activity Intervention for Adults with Mild Cognitive Impairment and Their Caregivers

项目摘要 这项研究考察了一个以理论为基础的、积极的、专注于健康的、量身定做的、由护士提供的家庭- 中心干预：“每日有意义的活动”(DEMA)。Dema是为老年人设计的 与轻度认知障碍(MCI)和家庭照顾者。65岁以上的美国人中有近20%患有MCI。 由于患者越来越缺乏信心，MCI患者的生活满意度降低。 以及执行有意义的和/或重要的活动的能力减弱，导致有意义的减弱 活动投入、抑郁症状和焦虑。照顾者缺乏信心来管理自己和 他们的病人每天都面临挑战，导致照顾者负担重、抑郁症状和焦虑。病人 和照顾者(双胞胎)报告说，由于以下原因，他们对沟通和关系的满意度下降 对病人的功能能力存在分歧。患者/护理者行为干预更多 如果它们发生在进展为痴呆症之前，则成功。之前的认知干预研究使用了 有限的、单一领域的关注(例如，认知培训、锻炼或营养)，可能没有足够的意义 保持足够长的患者参与度，以提高生活满意度。新出现的证据，包括我们的飞行员 研究表明，定期参加自我认同的有意义的活动可以提高生活满意度和 抑郁，降低患痴呆症的风险。这项随机对照试验的目的是 与信息支持(IS)注意控制组比较，确定DEMA的有效性。Dema：1)养育者 积极倾听有助于提高患者对功能能力的认同感；2)有助于增强 通过解决问题来评估对自我确定的有意义的活动的参与度和满意度， 确定优先顺序，并实现确定的有意义的活动目标；3)建立在患者现有兴趣和技能的基础上； 和4)提供信息和教学支持，以解决优先关注的问题和对双方的调整 职能转变和未来规划。具体目标是：1)测试DEMA对改善患者/ 护理人员的生活满意度；2)测试DEMA改善活动表现、抑郁症状和 患者的焦虑和照顾者的负担、抑郁症状和焦虑；以及，3)探索以下的子样本 与无抑郁症状的患者相比，具有更高抑郁症状的患者随着时间的推移健康结果有所改善 抑郁的病人。符合条件的患者/护理者二人组(n=200)将随机参加7个疗程的DEMA或IS 干预，数据收集在基线上，在9个月内收集了3次。混合模型效应将被分析。 如果有效，DEMA将通过维持患者和照顾者的 参与有意义的活动，以提高患者和照顾者的生活满意度，抑郁症状， 焦虑、关系满意度、活动表现和照顾者负担。它还将提供信息 关于患有更多抑郁症的患者可能受益的程度以及 翻译实践中干预措施的有效性。

PROJECT ABSTRACT This study examines efficacy of a theoretically-based, positive health focused, tailored, nurse-delivered, family- centered intervention: “Daily Engagement in Meaningful Activity” (DEMA). DEMA is designed for older persons with mild cognitive impairment (MCI) and family caregivers. Nearly 20% of Americans over 65 have MCI. Patients with MCI (patients) experience reduced life satisfaction due to patients’ increasing lack of confidence and diminished ability to perform meaningful and/or important activities, leading to diminished meaningful activity engagement, depressive symptoms, and anxiety. Caregivers lack confidence to manage their own and their patient’s daily challenges, leading to high caregiver burden, depressive symptoms, and anxiety. Patients and caregivers (dyads) report diminished satisfaction with their communication and relationship due to disagreements regarding the patient’s functional ability. Patient/caregiver behavioral interventions are more successful when they occur before progression to dementia. Previous cognitive intervention studies used limited, single domain foci (e.g., cognitive training, exercise, or nutrition) that may not be meaningful enough to sustain patient engagement long enough to improve life satisfaction. Emerging evidence, including our pilot studies, suggests regular engagement in self-identified meaningful activities can improve life satisfaction and depression and reduces risk of developing dementia. The purpose of this randomized controlled trial is to determine efficacy of DEMA compared to an information support (IS) attention control group. DEMA: 1) fosters active listening to increase dyad agreement in perceptions of patient functional ability; 2) helps dyads enhance engagement in and satisfaction with self-identified meaningful activities through problem solving to assess, prioritize, and achieve identified meaningful activity goals; 3) builds on patient’s existing interests and skills; and 4) provides information and didactic support to address priority concerns and dyad adjustment to functional changes and plan for the future. Specific aims are: 1) test DEMA’s efficacy for improve patient/ caregiver life satisfaction; 2) test DEMA’s efficacy to improve activity performance, depressive symptoms and anxiety in patients and burden, depressive symptoms, anxiety in caregivers; and, 3) explore a sub-sample of patients with higher depressive symptoms for improvement in health outcomes over time, compared to non- depressed patients. Eligible patient/caregiver dyads (n = 200) will be randomized to a 7-session DEMA or IS intervention, with data collected at baseline and 3 times over 9 months. Mixed model effects will be analyzed. If efficacious, DEMA will provide high impact on the care of patients and caregivers by maintaining their engagement in meaningful activities to improve patient and caregiver life satisfaction, depressive symptoms, anxiety, relationship satisfaction, activity performance, and caregiver burden. It will also provide information regarding the extent to which patients who have more depression may benefit and empirical evidence of the effectiveness of an intervention for translation into practice.