Changing Talk Online Training (CHATO): A National Trial to Reduce Behavioral Symptoms in Long Term Care Residents with Alzheimer's Disease and Other Dementias

项目摘要 2019冠状病毒病大流行极大地影响了对阿尔茨海默病患者和其他 痴呆症（ADOD）在长期服务和支持环境中的作用。值得注意的是，养老院的居民，包括一个 估计有50%或更多的人患有痴呆症，感染率极高， COVID-19的主要死亡人数。新的感染控制预防措施、法规和 已实施监测，以减少这些压倒性的影响，老年人在养老院 (NH)在乎感染控制预防措施的核心是使用个人防护设备（PPE）。虽然 减少新冠肺炎在NH中传播的一个必要和关键方面，PPE对 交流，痴呆症的行为和心理症状（BPSD），以及其他方面的护理 痴呆症患者仍有待解决。由于PPE对通信提出了额外的挑战， 在使用PPE的同时优化沟通的干预措施有可能改善痴呆症护理， 减少ADOD患者的负面反应，并通过确定以人为本的方式支持护理人员 最佳实践 我们的研究团队目前正在进行一项随机临床试验（R 01 AG 069171 - 06 A1），以测试在线 交流培训计划“改变在线谈话”（CHATO）。这一工作人员教育干预措施包括 三个循证培训模块，改善了沟通，减少了 NHS。CHATO实用性随机对照试验将测试CHATO对BPSD和使用 全国120个国家卫生机构为痴呆症患者提供精神药物。此外，我们将测试策略 让员工参与进来，最大限度地发挥CHATO的作用，并评估成本和可持续性， 传播。总体目标是为卫生部工作人员提供便利和支持，以改善沟通 这随后降低了BPSD和对精神活性药物的不适当和危险的需求 用来控制这些症状。 本行政补充文件（CHAT-PPE）将扩大我们R 01研究的范围，以：（1）确定证据- 在使用PPE时，基于最佳实践进行沟通;以及（2）创建并测试一个简短的培训模块， 护理人员单独使用或与CHATO培训结合使用。自我学习为主 在长期服务和支持环境中，穿戴PPE时的沟通至关重要， 照顾老年痴呆症患者。我们的研究证实了沟通在 痴呆症护理，注意到改善沟通减少了BPSD和抗精神病药物的需求 使用.我们的团队是唯一有资格确定沟通的最佳做法，然后开发和测试 采取干预措施，克服老年痴呆症护理中的PPE沟通障碍。这项研究符合NIA 目的开发新的干预措施，以满足痴呆照顾者和照顾者的需求。

Project Abstract The COVID-19 pandemic has greatly impacted care of persons living with Alzheimer’s disease and other dementias (ADOD) in long-term service and support settings. Notably, nursing home residents, including an estimated 50% or more who experience dementia, have extremely high rates of infection and comprise a predominant number of deaths from COVID-19. New infection control precautions, regulations, and surveillance have been implemented to reduce these overwhelming effects on older adults in nursing home (NH) care. Central to infection control precautions is the use of personal protective equipment (PPE). Although a necessary and critical aspect of reducing COVID-19 transmission in NHs, secondary effects of PPE on communication, behavioral and psychological symptoms of dementia (BPSD), and other aspects of care for persons with dementia remain to be addressed. As PPE presents additional challenges to communication, interventions to optimize communication while using PPE have the potential to improve dementia care by reducing negative reactions by persons with ADOD and supporting nursing staff by identifying person-centered best practices. Our research team is currently conducting a randomized clinical trial (R01 AG069171-06A1), to test an online communication training program “Changing Talk Online” (CHATO). This staff educational intervention includes three evidence-based training modules that have resulted in improved communication and reduced BPSD in NHs. The CHATO pragmatic randomized controlled trial will test the effects of CHATO on BPSD and on use of psychotropic medication for residents with dementia in 120 NHs nationwide. In addition, we will test strategies to engage staff and maximize CHATO effects and evaluate cost and sustainability for widespread dissemination. The overall goal is to provide ready access and support to NH staff to improve communication that subsequently reduces BPSD and the need for psychoactive medications inappropriately and dangerously used to control these symptoms. This administrative supplement (CHAT-PPE) will expand the scope of our R01 study to: (1) identify evidence- based best practices for communication while using PPE; and (2) create and test a brief training module for nursing staff to be used alone or in conjunction with the CHATO training. Strategies for effective communication while wearing PPE are of critical importance across long-term service and support settings that care for older adults with dementia. Our research established evidence of the importance of communication in dementia care, noting that improved communication reduced BPSD and the need for antipsychotic medication use. Our team is uniquely qualified to identify communication best practices and then to develop and test interventions to overcome PPE communication barriers in dementia care. This research meets the NIA objective to develop novel interventions to meet the needs of dementia caregivers and care recipients.