Promoting the "Good Life" among Nursing Home Residents with Alzheimer's Disease and Related Dementias: The Role of Special Care Units

项目摘要/摘要 许多65岁以上患有阿尔茨海默病和相关痴呆(ADRD)的成年人住在疗养院(NHS) 随着疾病的进展，接受先进的医疗护理和监督。然而，许多国民健康保险制度正在苦苦挣扎 在向患有ADRD的居民提供护理方面具有最佳做法。NH阿尔茨海默氏症特别护理病房(ASCUS) 是一些NHS中与更好的住院护理和结果相关的一个潜在的有希望的特征。然而，我们 尚未了解这些病房的特殊之处以及相关的特点和护理实践 带来有益的结果和改善的生活质量。这项独立之路提案将有助于 对于我们在一部小说中如何确保ADRD患者的“美好生活”的理解， 结构化、循证的方法，使候选人成为卫生服务领域的新兴领导者 致力于推进对ADRD患者护理的研究。在此目标1中获得的数据 提案将提供患有ADRD的居民、他们的家人和护理人员的重要第一手经验 在这一群体中提供关于生活质量和护理实践的信息。这些发现将被整合到一个 目标2中NH护理的循证“美好生活”模式，以及目标3中的小范围实施和评估 但严格的随机对照临床试验。这些目标与NIA的优先事项非常一致，包括 与护理有关的挑战和负担、长期支助和服务中的护理模式、 在获得医疗保健方面的差距，并促进ADRD患者的健康。总体而言，获得的知识 在这份提案中将通知后续的R01申请，对其进行更明确的审查 健康护理的“生命”模式。研究结果还将对ADRD患者及其家人、NHS、政策产生影响 关于如何在长期护理社区促进“美好生活”的制造者和研究人员。为了促进这一点 在通往独立的道路上，候选人已经从一位杰出的、高度成就的人那里建立了承诺 长期护理研究领域领先专家的导师团队，在NHS进行务实的临床试验， 定性和定量方法，以及直接住院护理。重要的是，这些成员成功地 他们之间以及与候选人之间目前和以前的合作，其中一个甚至在候选人的 论文委员会。除了创新的研究目标外，这项提案还将进行严格的培训 以及职业发展活动，旨在补充和促进候选人在关键研究方面的技能 领域：定性方法、实用的临床试验设计、翻译和实施科学、护理人员 在NHS跟踪观察直接住院护理、赠款写作、教学和学术演示以及 出版物。马里兰大学社会工作学院很高兴支持这项提议和所有相关的 候选人的活动。这条通往独立之路的提案是自然和必要的下一步 将候选人确立为独立的跨学科卫生服务研究人员和领导人，致力于 确定、优化和传播对ADRD患者的最佳护理做法。

Project Summary/Abstract Many adults over age 65 with Alzheimer’s disease and related dementias (ADRD) reside in nursing homes (NHs) to receive advanced medical care and supervision as the diseases progress. Yet, numerous NHs are struggling with best practices in the delivery of care to residents with ADRD. NH Alzheimer’s special care units (ASCUs) are one potentially promising feature in some NHs related to better resident care and outcomes. However, we are yet to understand what is ‘special’ about these units and the characteristics and care practices associated with beneficial outcomes and improved quality of life. This Pathway to Independence proposal will contribute substantially to our understanding of how to ensure the “Good Life” among residents with ADRD in a novel, structured, and evidence-informed approach, establishing the candidate as an emerging leader in health services research committed to advancing research on care for persons with ADRD. The data obtained in Aim 1 of this proposal will provide critical first-hand experiences from residents with ADRD, their families, and nursing staff providers on quality of life and care practices among this population. These findings will be integrated into an evidence-informed “Good Life” model of NH care in Aim 2 and implemented and evaluated in Aim 3 in a small but rigorous randomized controlled clinical trial. These Aims are well-aligned with NIA priorities including challenges and burdens associated with caregiving, models of care in long-term supports and services, disparities in health care access, and promoting health in persons with ADRD. Collectively, knowledge gained in this proposal will inform a subsequent R01 application to conduct a more definitive examination of the “Good Life” model of NH care. Findings will also have implications for persons with ADRD and their families, NHs, policy makers, and researchers on how to promote the “Good Life” in long-term care communities. To promote this Pathway to Independence, the candidate has established commitment from an exceptional, highly accomplished mentorship team of leading experts in long-term care research, conducting pragmatic clinical trials in NHs, qualitative and quantitative methodology, and direct resident care. Importantly, these members have successful current and prior collaborations amongst themselves and with the candidate, one even serving on the candidate’s dissertation committee. In addition to the innovative research Aims, this proposal will pursue rigorous training and career development activities designed to complement and further the candidate’s skills in key research areas: qualitative methods, pragmatic clinical trial design, translational and implementation science, caregiver shadowing in NHs to observe direct resident care, grant writing, teaching, and scholarly presentations and publications. The University of Maryland, School of Social Work is pleased to support this proposal and all related activities for the candidate. This Pathway to Independence proposal is the natural and necessary next step to establish the candidate as an independent interdisciplinary health services researcher and leader committed to identifying, optimizing, and disseminating best care practices for persons living with ADRD.