Medication Administration and Chemical Restraints in Family Caregiving for Alzheimer's Disease and Related Dementia

项目摘要 所有患有阿尔茨海默病和相关痴呆(ADRD)的人都会经历 痴呆(BSD)。BSD的管理是照顾者执行的最常见的日常任务之一，包括 决定何时“根据需要”使用药物来治疗BSD。非药理学策略是 建议的一线方法来管理BSD，尽管在非BSD的情况下，可以保证“根据需要”使用药物 药物策略失败，BSD要么给接受护理的人造成痛苦，要么危及 照顾者或照顾者的人身安全。相反，化学抑制意味着一种药物正在 给药是为了使照顾者的护理更方便，而不是因为它是医学上的指示。我们的团队 有报道称，22%的ADRD家庭照顾者不适当地将药物作为化学限制进行管理。 重要的是，对于患者的药物治疗管理，没有循证的适应症。 除了安全以外，为了照顾者的利益的症状。因此，这种高流行率令人担忧，而且 代表着一场新的公共卫生危机和知识的重大差距。考虑到这款新车的新颖性 描述现象，本研究的目的是描述药物给药的模式，化学 ADRD家庭照护中的约束和相关死亡结果。为解决这一问题，我们将进行31- 每日微观纵向研究，家庭照顾者(N=300)完成描述BSD的每日日记 管理包括非药物策略和药物的使用。这些数据将得到补充 通过登记调查获得照顾者的个人特征，临床特征 在他们的电子病历中找到的护理接受者，并结合生命记录数据，了解护理接受者的死亡率。这 拟议的研究将实施一种创新的算法，将药物管理归类为医学上的 考虑到尝试的非药物策略，指示的、潜在的不适当和化学限制， 安全顾虑和护理接受者的痛苦(目标1)。这项研究还将描述化学物质的模式 限制，以创建类型和确定化学品限制使用者的特征(目标2)，并确定 化学限制使用与护理接受者一年死亡率的关系(目标3)。这项研究是 创建敏感的临床评估以识别存在不良反应高风险的情况的第一步 与照看实践相关的结果。这项基础性工作将支持长期研究目标 评估随机对照顾者进行化学约束筛查是否会导致更大程度的降低发病率和 护理接受者的死亡率高于观察到的危害。

Project Abstract All persons with Alzheimer’s disease and related dementias (ADRD) will experience behavioral symptoms of dementia (BSD). Management of BSD is one of the most frequent daily tasks caregivers perform, which includes deciding when to administer an “as needed” medication to address BSD. Non-pharmacologic strategies are the recommended first-line approach to manage BSD, though “as needed” medications can be warranted when non- pharmacologic strategies fail and the BSD are either causing distress to the care recipient or jeopardizing the physical safety of the care recipient or caregiver. Conversely, chemical restraint means a drug is being administered to make care more convenient for the caregiver, not because it is medically indicated. Our team has reported that 22% of ADRD family caregivers inappropriately administer medications as chemical restraints. Importantly, there are no evidence-based indications for pharmacotherapeutic management of a patient symptom for the benefit of a caregiver, aside from safety. Thus, this high prevalence is concerning, and represents an emerging public health crisis and major gap in knowledge. Given the novelty of this newly described phenomenon, the purpose of this study is to describe patterns of medication administration, chemical restraint, and associated mortality outcomes in ADRD family caregiving. To address this, we will conduct a 31- day micro-longitudinal study in which family caregivers (N=300) complete daily diaries describing BSD management including use of non-pharmacologic strategies and medications. These data will be supplemented with personal characteristics of the caregivers obtained through an enrollment survey, clinical characteristics of care recipients found in their EHR and combined with vital records data on the care recipient’s mortality. This proposed study will implement an innovative algorithm to classify medication administration as medically indicated, potentially inappropriate and chemical restraint in consideration of non-pharmacologic strategies tried, safety concerns, and distress of the care recipient (Aim 1). This study will also characterize patterns of chemical restraint to create typologies and determine characteristics of chemical restraint users (Aim 2), and determine the relationship between chemical restraint use and 1-year mortality of the care recipient (Aim 3). This study is the first step towards creating sensitive clinical assessments to identify situations at high risk of adverse outcomes related to caregiving practices. This foundational work will support a long-term research goal to evaluate if randomizing caregivers to screening for chemical restraint results in greater reduced morbidity and mortality for care recipients than the observed harms.