Changing Talk Online Training (CHATO): A National Trial to Reduce Behavioral Symptoms in Long Term Care Residents with Alzheimer's Disease and Other Dementias

项目摘要 不断增长的痴呆症人口对提供高质量的护理提出了挑战 家庭(NH)护理。痴呆症的行为和心理社会症状(BPSD)使护理复杂化，例如 痴呆症患者丧失认知能力时出现的攻击性、发声、走神和退缩 和沟通能力，不能用语言表达未得到满足的身体和心理社会需求。NH员工 使用“长辈话”，类似于婴儿说话，是对居民的贬低。居民对老年人讲话的反应 随着BPSD导致更多地使用精神药物来控制BPSD，更高的人员需求，更多 员工压力大，人员流失率高，成本增加。Change Talk(Chat)培训计划教育员工 关于长辈语言和以人为中心的沟通策略，事实证明，它可以减少员工的长辈语言和 BPSD。要提高这种基于课堂的有效培训的影响，下一步是测试聊天内容 在在线互联网模块中提供。在线提供此培训(CHATO)可以改善繁忙员工的访问权限 以及农村和小型NHS中的那些人，以增加在护理环境中的传播，以改善痴呆症的护理。 这项持续的更新研究将测试一种新的在线版本的Chat，一种非药理学的 有效减少工作人员年长者语言交流并随后减少NH的BPSD的干预 患有痴呆症的居民。交互式CHATO模块提供灵活的培训途径， 工作人员可以通过互联网访问。在这项务实的试验中，120名NHS将被随机分配到Chato培训 或给对照组注射。BPSD和精神药物用药率数据，摘自医疗保险中心 与医疗补助服务养老院比较和最小数据集，将使用线性混合进行比较 模特儿。用于聘用员工(支付完成时间、认可)和其他支持的NH战略将是 根据工作人员参与率和成果衡量标准的变化进行分析。费用将由我们决定 关于成果的变化以及持续使用和加强培训的情况，将在 对参与调查的养老院进行为期一年的跟踪调查。这项研究的总体目标是为大规模的 循证非药物干预的规模传播和实施，以减少 为长期护理环境中的痴呆症患者提供RTC。 这项研究阐述了NIA的非药物痴呆症护理干预的里程碑 症状管理和照顾者支持任务，解决阿尔茨海默病的国家计划目标 为了提高护理质量和效率，阿尔茨海默氏症协会计划建立一支拥有高- 优质护理技能。当务之急是减少不适当地使用精神活性药物来控制BPSD 改善痴呆症护理的国家伙伴关系的目标。随着#年痴呆症患者人数增加三倍 在接下来的30年里，使护理提供者能够提供高质量的痴呆症护理至关重要。

Project Abstract The growing population of persons with dementia presents challenges to providing high quality nursing home (NH) care. Care is complicated by behavioral and psychosocial symptoms of dementia (BPSD) such as aggression, vocal outbursts, wandering, and withdrawal that occur as persons with dementia lose cognitive and communication abilities and cannot verbally express unmet physical and psychosocial needs. NH staff use “elderspeak,” speech similar to baby talk that is demeaning to residents. Residents react to elderspeak with BPSD resulting in increased use of psychotropic medication to control BPSD, higher staffing needs, more staff stress and turnover, and increased costs. The Changing Talk (CHAT) training program educates staff about elderspeak and person-centered communication strategies and is proven to reduce staff elderspeak and BPSD. The next step to increase the impact of this effective classroom-based training is to test CHAT content provided in online internet modules. Providing this training online (CHATO) can improve access for busy staff and those in rural and small NHs to increase dissemination across care settings to improve dementia care. This continuing renewal study will test a new, online version of CHAT, a nonpharmacological intervention that effectively decreases staff elderspeak communication and subsequently reduces BPSD in NH residents with dementia. The interactive CHATO modules provide flexible access to training, continuously accessible to staff via the internet. In this pragmatic trial, 120 NHs will be randomly assigned to CHATO training or to the control group. BPSD and psychotropic medication rate data, extracted from the Center for Medicare and Medicaid Services Nursing Home Compare and Minimum Data Set, will be compared using linear mixed modeling. NH strategies used to engage staff (paid time to complete, recognition) and other supports will be analyzed in relation to staff participation rates and changes in the outcome measures. Costs will be determined in relation to changes in the outcomes and ongoing use and reinforcement of training will be assessed at a one-year follow-up survey for participating nursing homes. The overall goal of this study is to prepare for large scale dissemination and implementation of this evidence-based nonpharmacological intervention to reduce RTC for residents with dementia across long term care settings. This research addresses NIA's milestones for nonpharmacological dementia care interventions, NINR's symptom management and caregiver support missions, the National Plan to Address Alzheimer's Disease goal to enhance care quality and efficiency, and the Alzheimer's Association Plan to build a workforce with high- quality care skills. Reducing inappropriate use of psychoactive medications to control BPSD is the top priority goal of the National Partnership to Improve Dementia Care. As the number of persons with dementia triples in the next 30 years, empowering care providers to provide high quality dementia care is of critical importance.