Caregiver Training to Manage Inappropriate Behaviors in Individuals with Alzheime

描述（由申请人提供）：阿尔茨海默氏病和相关痴呆（ADRD）联合收割机形成了21世纪世纪美国老龄化人口面临的紧迫的医疗保健挑战。在美国，2008年，每71秒就有一个人被诊断出ADRD;到2050年，这个数字将是每33秒一个。本提案报告正文中引用的当局ADRD是美国第三大最昂贵的疾病，尽管正在进行研究，但目前没有办法预防ADRD的发作，死亡是唯一确定的治愈方法。护理选择是复杂的，因为ADRD患者的认知和身体下降因人而异，没有单一的护理常规或协议是可预测的有效。此外，在超过80%的ADRD患者中发现了不适当的行为，这给注册护士助理（CNA）带来了巨大的压力和负担。虽然行为管理策略自20世纪80年代以来一直主导着ADRD文献，但许多医疗主任和其他ADRD机构的专业人员往往缺乏准备或时间来回应CNA在管理问题行为方面的帮助请求。然而，在ADRD护理方面经验丰富的各种当局表明，当CNA在这一领域接受持续教育和技能培训时，会产生可衡量的积极效果。因此，第一阶段的努力旨在教育CNA掌握有效调解ADRD患者问题行为所需的知识和技能，并通过创新的、基于互联网的原型提供具有挑战性的、信息丰富的、基于应用的课程。该产品超越了传统的CNA教育和在职培训的被动方法，而是提供多媒体功能，如访谈，护理模型，流媒体视频和在线互动。通过这个原型，CNA测试人员可以方便地24/7私人访问整个干预顾问和治疗支持专家团队，他们在管理ADRD相关问题行为方面经验丰富。这一原型产生的改进做法的分散效果也可能有助于多层次的干预，从而以许多积极的方式影响到护理接受者本身及其亲人。除了其强大的商业潜力外，拟议的第一阶段培训产品还能够在社区教育、军队和退伍军人医院和服务、医疗办公室、医疗机构、教会外展计划和工作场所等不同场所造福公共卫生。在第二阶段，一个随机对照试验将测试完成的产品，并在第三阶段进行商业化。这一努力的所有阶段的平行好处之一很可能是减少ADRD对美国医疗保健系统的直接和间接成本。公共卫生相关性：所提出的努力与国家的公共卫生有关，因为在2008年期间，520万所有年龄段的美国人患有阿尔茨海默病和相关痴呆症（ADRD），这意味着每71秒就有一个ADRD诊断（阿尔茨海默病事实和数据，2008年，第8页）。ADRD的经济成本包括Medicare和Medicaid的直接成本1480亿美元（不包括退伍军人事务部、私人医疗保健和长期护理保险支付的费用），估计为国家医疗保健系统节省了2670亿美元，因为980万家庭成员至少提供了70%的医疗服务。对那些在家里而不是在疗养院治疗ADRD而没有报销的人的护理。此外，ADRD护理与护理人员的心理社会成本密切相关，护理人员必须直接对ADRD认知下降的患者表现出的不适当行为做出反应（阿尔茨海默病事实和数据，2008）。

DESCRIPTION (provided by applicant): Alzheimer's Disease and related dementias (ADRD) combine to form an urgent healthcare challenge facing the aging population of 21st Century America. In the U.S. during 2008, one person receives an ADRD diagnosis every 71 seconds; by 2050, that number will be one every 33 seconds. Authorities cited in the body of this proposal report ADRD are the third most costly disease sets in the U.S. In spite of ongoing research efforts, at present there is no way to prevent onset of ADRD, and death is the only certain cure. Caregiving options are complicated because the cognitive and physical declines of those with ADRD differ for each person, and no single care routine or protocol is predictably effective. Further, inappropriate behaviors are seen in more than 80% of individuals with ADRD, causing immense stress and increased burden to Certified Nursing Assistants (CNAs). Although behavior management strategies have dominated the ADRD literature since the 1980s, many medical directors and other ADRD facility professionals often lack either the preparation or the time to respond to CNAs' requests for help in managing problematic behaviors. Various authorities experienced in ADRD care, however, suggest measurable positive effects result when CNAs receive ongoing education and skill training in this area. This Phase I effort aims therefore to educate CNAs in the knowledge and skills they need to effectively mediate problematic behaviors of those afflicted with ADRD and to do so through an innovative, Internet based prototype presenting a challenging, informative, application- based curriculum. This product exceeds traditional passive methods of CNA education and in-service training and provides instead multi-media features such as interviews, care models, streaming videos, and online interaction. Through this prototype, CNA testers gain convenient, 24/7, private access to a whole team of intervention consultants and therapeutic support specialists experienced in managing ADRD-related problem behaviors. The dispersed effects of improved practice resulting from this prototype may also facilitate a multi-level intervention with power to affect in many positive ways the care recipients themselves as well as their loved ones. In addition to its strong commercial potential, the proposed Phase I training product has the capacity to benefit public health in venues as diverse as community education, military and veterans' hospitals and services, medical offices, healthcare agencies, church-based outreach programs, and workplace settings. During Phase II, a randomized control trial will test the completed product, and commercialization will be undertaken during Phase III. One of the parallel benefits of all phases of this effort may well be the reduction of both direct and indirect costs of ADRD to U.S. health care systems. PUBLIC HEALTH RELEVANCE: The proposed effort is relevant to the nation's public health because during 2008, 5.2 million Americans of all ages have Alzheimer's Disease and Related Dementias (ADRD), which translates to one ADRD diagnosis every 71 seconds (Alzheimer's Disease Facts and Figures, 2008, p. 8). The economic cost of ADRD includes $148 billion in direct costs to Medicare and Medicaid (not including the costs paid for by the Department of Veterans' Affairs, private health care, and long-term care insurance), and an estimated $267 billion savings to the national healthcare system because 9.8 million family members deliver at least 70% of the care for those with ADRD at home without reimbursement instead of in nursing homes. Further, ADRD care is strongly associated with psychosocial costs to caregivers, who must respond directly to the inappropriate behaviors exhibited by those in the cognitive declines of ADRD (Alzheimer's Disease Facts and Figures, 2008).