Reducing Disability via a Family-centered Intervention for Acutely-ill Persons with Alzheimer's Disease and Related Dementias

摘要 患有阿尔茨海默病和相关痴呆症(ADRD)的老年人患阿尔茨海默病和相关痴呆症的可能性是 作为认知健康的同龄人住院治疗。ADRD住院患者的护理 历来专注于导致入院的急性医疗问题，而很少关注 功能恢复。患有ADRD的老年人功能衰退和增加的风险更大 出院后的护理依赖是由于内在因素、环境、政策和 限制身体和认知活动的护理做法，以及工作人员对痴呆症护理的有限知识。 家庭照顾者(CGs)在促进住院患者功能恢复中发挥重要作用 上了年纪的人。他们可以提供重要的信息，提供动力和支持以功能为重点的护理， 并在不同程度上承担提供和协调急性后护理的责任。家庭- CENTERED FFC(FAM-FFC)结合了针对家庭CG提供的教育赋权模式 在社会生态住院框架内促进对ADRD患者的专门护理。这个 干预措施通过环境和政策为ADRD患者创造了一个“有利”的环境 评估/修改、员工教育、基于单位的冠军和个性化目标设置 重点是功能恢复。在这种以患者/家庭为中心的护理方法中，护士有目的地 让家庭CGs参与评估、决策、护理提供和功能评估- 住院期间和急性发作后60天期间的重点护理。在拟议的项目中，我们将 在6个医院单位对438名患者/CG二元组进行的整群随机试验中实施FAM-FFC 在三家医院(每单位73对)内随机进行，以实现以下目标：目标1：验证 FAM-FFC对运动功能(ADLS/操作和体力活动)、精神错乱的疗效 发生和严重程度、神经精神症状和情绪；目标2：评估Fam的影响- FFC关于以家庭CG为中心的结果(照顾准备、压力、负担和渴望 制度化)；目标3：评估FAM-FFC与控制条件的相对成本，并计算 FAM-FFC的卫生保健成本(急性后卫生保健利用)和节省的总成本。双星将会是 由居住在社区的极轻至中度痴呆症住院内科患者组成 (在临床痴呆症评定量表上从0.5到2.0)和他们的CG(定义为提供 监督和持续支持)。结果将在入院时进行评估， 出院后2个月和6个月。这项研究将是描述如何 与家庭CGs合作，改变向ADRD患者提供的急性护理方法，以 优化出院后的功能，促进这些人精神错乱的减轻和幸福。 帮助患有阿尔茨海默病和相关痴呆的老年人的社会影响 避免功能衰退在老龄化、生活质量、成本和照顾者方面都是巨大的 负担。这项研究结果将与急性护理中行为改变研究的其他领域相关， 特别是与让患者和家属参与卫生保健计划、提供和 评估。

Abstract Older persons with Alzheimer’s disease and related dementias (ADRD) are about two times as likely to be hospitalized as their peers who are cognitively healthy. The care of hospitalized persons with ADRD has traditionally focused on the acute medical problem that led to admission with little attention paid to functional recovery. Older persons with ADRD are at greater risk for functional decline and increased care dependency after discharge due to a combination of intrinsic factors, environmental, policy, and care practices that restrict physical and cognitive activity, and limited staff knowledge of dementia care. Family caregivers (CGs) can play an important role in promoting the functional recovery of hospitalized older adults. They can provide vital information, offer motivation and support of function-focused care, and assume responsibility in varying degrees for post-acute care delivery and coordination. Family- centered FFC (Fam-FFC) incorporates an educational empowerment model for family CGs provided within a social-ecological in-patient framework promoting specialized care to patients with ADRD. The intervention creates an “enabling” milieu for the person with ADRD through environmental and policy assessment/modification, staff education, unit-based champions, and individualized goal setting that focuses on functional recovery. In this patient/family-centered care approach, nurses purposefully engage family CGs in the assessment, decision-making, care delivery and evaluation of function- focused care during hospitalization and the 60-day post-acute period. In the proposed project, we will implement Fam-FFC in a cluster randomized trial of 438 patient/CG dyads in six hospital units randomized within three hospitals (73 dyads per unit) to accomplish the following aims: Aim 1: Validate the efficacy of Fam-FFC on physical function (ADLs/ performance and physical activity), delirium occurrence and severity, neuropsychiatric symptoms, and mood; Aim 2: Evaluate the impact of Fam- FFC on family CG-centered outcomes (preparedness for caregiving, strain, burden, and desire to institutionalize); and Aim 3: Evaluate the relative costs for Fam-FFC v. control condition, and calculate health care cost (post-acute health care utilization) and total cost savings for Fam-FFC. Dyads will be composed of community-residing, hospitalized medical patients with very mild to moderate dementia (0.5 to 2.0 on the Clinical Dementia Rating Scale) and their CG (defined as the primary person providing oversight and support on an ongoing basis). Outcomes will be evaluated at hospital admission, discharge, two and six months post-discharge. This study will be a critical next step in delineating how to partner with family CGs to change acute care approaches provided to patients with ADRD so as to optimize function after discharge, and promote delirium abatement and well-being in these individuals. The societal implications of helping older individuals with Alzheimer’s disease and related dementias avoid functional decline are enormous in terms of aging in place, quality of life, cost, and caregiver burden. The study findings will be relevant for other areas of behavior change research in acute care, specifically those related to engaging patients and families in health care planning, delivery, and evaluation.