The Residential Care Transition Module

 描述(由申请人提供)：关于家庭照料和制度化的最新研究发现，在亲属入住长期护理机构后，家庭并未脱离护理责任。相反，家庭仍然参与到 护理活动的范围从日常生活的工具性活动到情感支持。也许出于这些原因，一些研究已经注意到，在某些类型的照顾者进入住院长期护理(RLTC)后，照看压力、抑郁或其他关键结果保持稳定，有时会增加。一些干预措施试图在制度化后增加家庭的参与，但没有严格的研究表明这些干预措施在帮助家庭顺利过渡到RLTC环境方面有效。住宿护理过渡模块(RCTM)在4个月的时间内为最近接纳亲属进入RLTC环境的家庭照顾者提供6次正式咨询会议(一对一和家庭会议)。在这项随机对照试验中，在过去3个月中，相对于RLTC环境收治过认知障碍的家庭成员将被随机分配到RCTM[(n=120)]或普通护理控制条件[(n=120)]。将使用混合方法分析来实现以下目标：具体目标1)评估RCTM是否在家庭成员的主要主观压力和消极心理健康结果方面产生统计上的显著减少；具体目标2)确定接受RCTM的家庭成员在12个月期间是否会表现出与常规护理对照组相比次要角色压力的统计显著减少；具体目标3)确定RCTM家庭成员报告的居家护理压力是否与通常护理对照组中的家庭成员相比在统计学上显著减少；具体目的4)通过在12个月评估结束时“嵌入”定性成分(30个半结构化访谈)来描述RCTM在高成功和低成功条件下的作用机制。拟议的项目将通过评估为安置RLTC后的家庭设计的心理社会干预措施来填补一个重要的临床和研究空白，该干预措施确定RCTM是否以及如何帮助家庭更好地适应认知障碍亲属的住宿护理过渡。

 DESCRIPTION (provided by applicant): Emerging research on family caregiving and institutionalization has found that families do not disengage from care responsibilities following relatives' admissions to residential long-term care settings. Families instead remain involved in a spectrum of care activities ranging from instrumental activities of daily living to emotional support. Perhaps for these reasons, a number of studies have noted that caregiving stress, depression, or other key outcomes remain stable or sometimes increase following residential long-term care (RLTC) entry for certain types of caregivers. A few interventions have attempted to increase family involvement after institutionalization, but no rigorous studies have demonstrated that these interventions are effective in helping families navigate transitions to RLTC environments. The Residential Care Transition Module (RCTM) provides 6 formal sessions of consultation (one-to-one and family sessions) over a 4-month period to those family caregivers who have recently admitted a relative to a RLTC setting. In this randomized controlled trial, family members who have admitted a cognitively impaired relative to a RLTC setting in the past 3 months will be randomly assigned to the RCTM [(n = 120)] or a usual care control condition [(n = 120)]. A mixed methods analysis will be used to pursue the following aims: Specific Aim 1) Assess whether the RCTM yields statistically significant reductions in family members' primary subjective stress and negative mental health outcomes; Specific Aim 2) Determine whether family members who receive the RCTM will indicate statistically significant decreases in secondary role strains over a 12-month period when compared to usual care controls; Specific Aim 3) Determine whether RCTM family members report statistically significant decreases in residential care stress when compared to family members in the usual care control group; and Specific Aim 4) Delineate the mechanism of action of RCTM under conditions of high and low success by "embedding" qualitative components (30 semi-structured interviews) at the conclusion of the 12-month evaluation. The proposed project will fill an important clinical and research gap by evaluating a psychosocial intervention designed for families following RLTC placement that determines whether and how the RCTM can help families better navigate the residential care transitions of cognitively impaired relatives.