Person-Centered and Task-Centered Care in Temporal Relation to Mealtime Difficulties and Food Intake for Nursing Home Residents with Dementia

项目总结/摘要 患有阿尔茨海默病和相关痴呆症（ADRD）的人通常经历功能性， 认知和行为症状干扰摄入过程（进餐困难），导致 食物和液体摄入量低，以及各种负面的功能和营养后果。尽管增加了 风险和后果的进餐时间困难和低摄入量，照顾者既不准备也不帮助， 管理这两个重要和相互关联的公共卫生问题。当前痴呆症用餐时间 护理计划主要侧重于喂养技术，未能满足护理人员对知识和 提供最佳用餐时间护理的技能。以人为本的护理（PCC），直接定制并交付给 居民，而不是以任务为中心的护理（TCC），重点是完成任务，无论居民 需要，强烈建议用餐时间。虽然关于PCC在进餐期间的作用的证据正在出现， 很少有研究关注PCC与TCC对更广泛的进餐困难和摄入量的影响 结果是暂时的，限制了有效护理人员培训计划的发展。解决 这一差距，本项目的目标是确定模式和分布和时间协会 a）照顾者PCC和TCC行为，和B）居民进餐困难和摄入之间的关系。我们的团队是 很好地完成了这个项目，因为：a）我们有机会获得111个照顾者的录像， 来自先前R 01的居民进餐时间互动; B）我们开发并验证了提示利用率， 参与痴呆症（CUED）进餐时间视频编码计划作为一种创新，可行和可靠的工具， 评估a）照顾者PCC和TCC行为，和B）居民进餐困难和摄入。描述性 统计学将被用来描述编码行为的模式和分布（目标1）; 分析以检查其时间关联（目标2）。这个项目非常适合该计划 宣布在ADRD研究中培养下一代临床研究人员，并支持 创新的研究领域，有显着的需求，以改善护理ADRD。这个项目是关键的第一步 完成申请人的长期目标作为一个早期阶段的研究者谁是开发一项研究 解决最佳进餐时间护理的计划，以尽量减少ADRD的进餐困难和低摄入量。结果 这项研究将用于准备一个更大的随机对照试验，将开发和评估一个创新的进餐时间， 护理人员培训计划，为护理人员提供最大化（最小化）使用 减少（触发）进餐困难和改善（减少）摄入量的具体护理方法。下一 这一步骤补充了NIA的战略重点，以支持和开展老龄化和ADRD的行为研究 人口，以改善健康，福祉和功能，因为他们的年龄。此外，这项研究的结果是必不可少的， 提供培训护理人员的成本理由，因为使用有效的护理方法， 居民破坏性行为在减少工作人员用餐时间护理的时间和工作量方面具有很大的潜力。

Project Summary/Abstract Persons living with Alzheimer’s Disease and Related Dementias (ADRD) commonly experience functional, cognitive and behavioral symptoms that interfere with the intake process (mealtime difficulties), which lead to low food and fluid intake, and various negative functional and nutritional consequences. Despite increased risks and consequences of mealtime difficulties and low intake, caregivers are neither prepared nor aided in the management of these two significant and interrelated public health problems. Current dementia mealtime care programs primarily focus on feeding techniques, and fail to address caregiver needs for knowledge and skills in providing optimal mealtime care. Person-centered care (PCC) that is directly tailored and delivered to residents, rather than task-centered care (TCC) that focuses on completion of tasks regardless of resident needs, is highly recommended for mealtime. While evidence on the role of PCC during mealtime is emerging, little work has looked at the impact of PCC vs TCC on a broader array of mealtime difficulties and intake outcomes in a temporal manner, limiting the development of effective caregiver training programs. To address this gap, the objective of this project is to identify the patterns and distributions of and temporal associations between a) caregiver PCC and TCC behaviors, and b) resident mealtime difficulties and intake. Our team is well positioned to accomplish this project in that: a) we have access to 111 video recordings of caregiver- resident mealtime interaction from a prior R01; b) we developed and validated the Cue Utilization and Engagement in Dementia (CUED) mealtime video-coding scheme as an innovative, feasible and reliable tool to assess a) caregiver PCC and TCC behaviors, and b) resident mealtime difficulties and intake. Descriptive statistics will be used to characterize the patterns and distributions of coded behaviors (Aim 1); and sequential analysis to examine their temporal associations (Aim 2). This project is well-suited to the program announcement for developing the next generation of clinical researchers in ADRD research, and supporting innovative areas of research with significant needs to improve care for ADRD. This project is a critical first step to accomplish the long-term goal of the applicant as an early stage investigator who is developing a research program addressing optimal mealtime care to minimize mealtime difficulties and low intake in ADRD. Results of the study will be used to prepare a larger RCT that will develop and evaluate an innovative mealtime caregiver training program, preparing caregivers with knowledge and skills in maximizing (minimizing) the use of specific care approaches that reduce (trigger) mealtime difficulties and improve (decrease) intake. This next step complements the NIA strategic focus to support and conduct behavioral research in aging and ADRD population to improve health, well-being, and function as they age. Further, findings of this study is essential in providing a cost rationale for training caregivers in that the use of effective care approaches that reduce resident disruptive behaviors has great potential in reducing staff time and workload during mealtime care.