Telephone-Delivered Coping Improvement Intervention for HIV-Infected Older Adults

描述（由申请人提供）：截至2003年12月，美国有超过57,000名55岁或以上的人被诊断患有艾滋病。由于艾滋病研究人员主要关注感染艾滋病毒的年轻人，因此很少有适合年龄的干预措施来提高感染艾滋病毒/艾滋病的老年人的生活质量。从2001年到2004年，P.I.得到NIA的支持，对90名感染艾滋病毒的老年人使用电话会议技术进行了应对改善小组干预的试点测试。结果分析显示，干预降低了参与者的心理症状、生活压力源负担、适应不良应对策略的使用水平，并提高了应对自我效能。在我们的试点研究取得成功之后，本申请建议评估电话提供的应对改善小组干预对360名种族和地理上不同的艾滋病毒感染老年人的调整努力的影响，这与电话提供的信息支持小组干预和护理标准比较条件有关。与我们的试点干预类似，应对干预将以Lazarus和Folkman（1984）的压力与应对的交易模型为指导，并将使用认知行为原则来提高压力评估、应对决策和获得社会支持的技能。参与者将在干预前、干预后以及4个月和8个月的随访中完成自我管理的调查，评估合并症健康状况、认知功能、精神困扰、生活压力源负担、应对方式、应对自我效能和社会支持的患病率。在进行传统的统计干预结果和中介分析之后，将通过确定在关键结果测量上报告有临床意义变化的干预参与者的比例来进一步评估干预的有效性。此外，本研究将评估电话会议提供的干预措施在这一群体中产生有益变化的过程（例如，电话群体环境的哪些特征与结果测量的有益变化最相关？）。如果成功，这项研究将确定一种电话传递的干预措施，可以改善感染艾滋病毒的老年人的生活质量，否则这些老年人可能由于地理隔离、身体限制和保密问题而无法获得精神卫生支持服务。

DESCRIPTION (provided by applicant): Through December 2003, more than 57,000 persons in the U.S. were 55 years of age or older when they were diagnosed with AIDS. Because AIDS researchers have focused primarily on younger persons living with HIV disease, there are very few age-appropriate interventions to enhance life quality in older persons living with HIV/AIDS. From 2001-2004, the P.I. was supported by NIA to pilot test a coping improvement group intervention delivered using teleconference technology with 90 HIV-infected older adults. Outcome analyses revealed that the intervention reduced participants' levels of psychological symptoms, life-stressor burden, and use of maladaptive coping strategies and increased coping self-efficacy. Following the success of our pilot research, this application proposes to evaluate the impact of a telephone-delivered, coping improvement group intervention on the adjustment efforts of 360 ethnically- and geographically-diverse HIV- infected older adults in relation to a telephone-delivered, information support group intervention and a standard of care comparison condition. Similar to our pilot intervention, the coping intervention will be guided by Lazarus and Folkman's (1984) Transactional Model of Stress and Coping and will use cognitive- behavioral principles to improve skills in stress appraisal, coping decisions, and obtaining social support. Participants will complete self-administered surveys at pre-intervention, post-intervention, and 4- and 8- month follow-up that assess the prevalence of comorbid health conditions, cognitive functioning, psychiatric distress, life-stressor burden, ways of coping, coping self-efficacy, and social support. Following the conduct of traditional statistical intervention outcome and mediational analyses, the intervention's efficacy will be further evaluated by identifying the proportion of intervention participants who report clinically-meaningful changes on key outcome measures. Furthermore, this research will evaluate the process by which teleconference-delivered interventions produce beneficial changes in this group (e.g., what characteristics of the telephone group environment are most related to beneficial changes in outcome measures?). If successful, this research will identify a telephone-delivered intervention that can improve life quality in HIV- infected older adults who might otherwise lack access to mental health support services due to geographic isolation, physical limitations, and confidentiality concerns.