Improving Care Transitions and Self-care among Informal Caregivers of Hospitalized Older Adults through Digital Tools

非正式的护理要求很高，压力也很大，尤其是在处理住院治疗的时候。许多照顾者 最终成为护理接受者，因为多年的压力和延迟的自我护理使他们处于更高的水平 有患病的风险。自我护理是指为保持健康和控制疾病而采取的行为。从事 自我护理可能会改善健康状况(身体功能和精神健康)。患有多发性硬化症的老年人 慢性病(MCC)通常依赖于照顾者的帮助，特别是在住院后，当 照顾者通常被期望遵循复杂的出院计划，并在家里管理复杂的熟练护理。 护理缺口和故障的影响耗费了自我护理的时间，并给照顾者带来了巨大的压力。 健康指导是一种支持干预措施，可以改善患者的自我护理，但研究评估了照顾者和 种族差异是有限的。对护理者支持干预措施对患者的影响知之甚少 结果。利用技术和互联网接入日益增长的可用性和不断下降的成本-以及 新冠肺炎之后增加了虚拟护理的接受度-我们开发并测试了一个同步的虚拟 支持干预，Viccy(为您提供虚拟护理教练)，其中10个视频会议会议 由训练有素的教练讲授，为期六个月，重点是自我照顾、应对和压力。在此应用程序中，我们 建议加强Viccy议定书，以在急性护理期间(期间/后)针对照顾者 住院)以及与数字健康信息(DHI)相比，对患有MCC的老年人的护理过渡 单独(对照组)。使用随机对照试验(RCT)设计，我们将招募非正式照顾者 较差的自我照顾(健康自我照顾忽视量表评分≥2)，并将照顾者随机分为1：1到 干预组或对照组，按照顾者性别、种族和与患者的关系进行分层随机分组。 两组都将通过一个专门为护理过渡和自我护理信息量身定做的网站获得DHI， 而干预组也将收到Viccy。在基线、3个月和6个月时，我们将收集自我报告 关于自我护理、压力、应对和健康状况的数据。出院后1个月护理过渡 经验将被收集起来。在6个月后，我们将比较Viccy和DHI单独评估干预效果 使用意向治疗分析。250名照顾者的样本(125个/ARM)将提供80%的力量来检测显著的 两组之间在自我护理的主要结果(目标1)上的差异以及自我护理的程度 在目标1中，黑人/AA和白人照顾者之间的改善结果将是相似的(目标2)。去探索 照顾者结果对患者结果的影响我们将检查急性护理资源的使用 (再入院等)为期6个月(目标3)。知道不是所有的患者都会参与，我们会 同意由这些照顾者照顾的住院老年人中的一个小组(至少40个二元组)。如果显示 为了有效，我们的虚拟健康教练干预可以很容易地扩展到支持数百万护理人员 全世界。本申请涉及NIA战略计划，并响应NOSI NOT-CA-22-037。

Informal caregiving is demanding and stressful especially when dealing with a hospitalization. Many caregivers eventually become care recipients themselves as years of stress and deferred self-care put them at increased risk for illness. Self-care refers to the behaviors undertaken to maintain health and manage illness. Engaging in self-care may improve health status (physical functioning and mental well-being). Older adults with multiple chronic conditions (MCCs) often depend on caregivers for assistance, especially after a hospitalization, when caregivers are often expected to follow complicated discharge plans and manage complex skilled care at home. The impact of care gaps and breakdowns saps time for self-care and causes significant stress for caregivers. Health coaching, a support intervention, can improve self-care in patients, but studies evaluating caregivers and racial differences are limited. Less is known about the effect of caregiver support interventions on patient outcomes. Leveraging the growing availability and declining costs of technology and internet access—along with increasing receptivity of virtual care in the wake of COVID-19—we developed and tested a synchronous virtual support intervention, ViCCY (Virtual Caregiver Coach for You), where 10 video conference sessions are delivered by a trained coach over six months that focus on self-care, coping, and stress. In this application, we propose to augment the ViCCY protocol to target caregivers during an acute care episode (during/post- hospitalization) and transitions in care for older adults with MCCs compared to digital health information (DHI) alone (control group). Using a randomized controlled trial (RCT) design, we will enroll informal caregivers with poor self-care (Health Self-Care Neglect scale score ≥2), and block randomize the caregivers 1:1 to the intervention or control group, stratifying randomization by caregiver sex, race, and relationship to the patient. Both groups will receive DHI delivered through a website tailored with care transitions and self-care information, and the intervention group will also receive ViCCY. At baseline, 3-, and 6-months, we will collect self-reported data on self-care, stress, coping, and health status. At 1-month post-hospital discharge the care transitions experience will be collected. At 6-months, we will compare ViCCY to DHI alone to assess intervention efficacy using intent-to-treat analysis. A sample of 250 caregivers (125/arm) will provide >80% power to detect significant differences between the groups on the primary outcome of self-care (Aim 1) and that the magnitude of improvement will be similar in outcomes in Aim 1 between Black/AA and White caregivers (Aim 2). To explore the effect of caregiver outcomes on patients’ outcomes we will examine acute care resource use (rehospitalization, etc.) over a 6-month period (Aim 3). Knowing that not all patients will participate, we will consent a subgroup of the hospitalized older adults cared for by these caregivers (at least 40 dyads). If shown to be efficacious, our virtual health coaching intervention can easily scale to support millions of caregivers worldwide. This application addresses the NIA strategic plan and is in response to NOSI NOT-CA-22-037.