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 痴呆症患者人数的不断增长对提供高质量护理提出了挑战 家庭护理（Home Care）痴呆症的行为和心理社会症状（BPSD）使护理变得复杂，例如 痴呆症患者丧失认知能力时出现的攻击、言语爆发、徘徊和退缩 和沟通能力，不能口头表达未得到满足的身体和心理社会需求。NH工作人员 使用“老人话”，类似于婴儿说话的语言，这是贬低居民。居民对老年人语言的反应 由于BPSD导致更多地使用精神药物来控制BPSD， 工作人员的压力和更替以及成本增加。Changing Talk（CHAT）培训计划教育员工 关于老年人语言和以人为本的沟通战略，并被证明可以减少工作人员的老年人语言， BPSD。提高这种有效的课堂培训效果的下一步是测试聊天内容 提供在线互联网模块。提供在线培训（CHATO）可以改善忙碌员工的访问 以及那些在农村和小型国家卫生机构，以增加在护理环境中的传播，以改善痴呆症护理。 这项持续的更新研究将测试一种新的在线版本的CHAT，一种非药物性的 有效减少工作人员老年人语言交流的干预措施，从而降低NH的BPSD 老年痴呆症患者交互式CHATO模块提供灵活的培训途径， 工作人员可通过互联网查阅。在这项务实的试验中，120名护理人员将被随机分配到CHATO培训 或对照组。BPSD和精神药物使用率数据，摘自医疗保险中心 和Medicaid Services Nursing Home Compare和最小数据集，将使用线性混合 建模NH用于吸引员工的策略（带薪完成时间，认可）和其他支持将 分析了工作人员参与率和结果指标的变化。费用将由 将在一次会议上评估与成果变化以及培训的持续使用和强化有关的问题， 对参与的护理院进行为期一年的跟踪调查。本研究的总体目标是为大型 大规模传播和实施这种循证非药物干预，以减少 RTC为长期护理机构中的痴呆症患者提供服务。 这项研究解决了NIA的非药物性痴呆护理干预的里程碑，NINR的 症状管理和照顾者支持任务，国家计划，以解决阿尔茨海默病的目标 提高护理质量和效率，阿尔茨海默氏症协会计划建立一支高素质的工作队伍， 优质护理技能。减少精神活性药物的不适当使用以控制BPSD是重中之重 国家伙伴关系的目标，以改善痴呆症护理。随着老年痴呆症患者人数在2010年增加两倍， 在未来30年，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.