Teaching Resourcefulness to Women Caregivers of Elders with Dementia

描述(由申请人提供)：向患有痴呆症的老年女性照顾者教授足智多谋这项R21探索性研究拨款的主要目标是试点、测试和完善一种适应的干预措施，向女性痴呆症照顾者(CG)传授足智多谋的技能。足智多谋训练(RT)干预有坚实的理论基础，初步的经验证据表明，它在减轻压力、最大限度地减少抑郁症状、提高女性痴呆症患者以外的人群的最佳生活质量方面是有效的。这项拟议的为期两年的试点研究将提供定性和定量数据，以确定两种创新设计的RT方法的必要性、可接受性、可行性、保真度、安全性和有效性。这项研究是在一项有120名女性痴呆症患者参加的小型部分随机偏好试验的背景下进行的。在RT中，两种测试方法(表现性写作和言语披露)被用来练习/加强足智性技能。然而，由于研究表明EW和VD都可能是有效的减压技术，我们也将在没有RT的情况下检查这些影响。我们建议，由电子战或痴呆症加强的RT将为CGs提供必要的技能，以管理压力和保持心理和身体健康，同时为他们的老年照顾者(CRS)提供护理。在基线(T1)、干预后1周(T2)和6周(T3)收集关于压力、认知、情绪、足智性和身心健康的量化数据。定性数据将从CG期刊(EW)/记录(VD)、数据收集者的实地笔记、跟踪日志等获得。基线足智量表(RS)分数和来自期刊/记录的定性数据将用于检查RT的必要性。CGS将随机分为“随机”或“选择”状态，并对其数据(即日记、录音、实地笔记、跟踪记录、参与/保留记录)进行检查，以确定RT的可接受性、可行性和保真度。RT的安全性将受到监测，看是否有不良事件和心理困扰或虐待老人的报告。RT-EW和RT-VD的有效性(与没有RT的EW和VD相比)将与足智性理论建议的特定结果相关，并与CG、CR和CG情况中的因素相关。最重要的是，我们将了解给CGs一个选择EW或VD加或不加RT是否会改善他们的结果。从这六个干预参数的关键检查中得出的结论将有助于在一项全面的随机对照试验中进一步完善和测试治疗痴呆性脑病的RT。一旦建立这种干预措施，将有助于促进痴呆症CGs的最佳、健康的功能，使他们能够继续为其CRS提供足够的护理，而不会牺牲自己的健康，并避免将老年人安置在长期护理机构中。与公共健康相关的痴呆症是美国老年人面临的最大挑战之一，几十年来，痴呆症护理的公共健康意义一直渗透在科学和非专业文献中。尽管有许多临床试验测试了减轻照顾者压力的干预措施，但没有一项试验测试过教授他们足智多谋技能的方法，也没有一项试验允许照顾者选择首选的干预措施。足智性培训是本研究中要测试的干预措施，它是一种成本效益高、易于使用的方法，可以减轻照顾者的压力，促进他们最佳的心理健康。

DESCRIPTION (provided by applicant): Teaching Resourcefulness to Women Caregivers of Elders with Dementia The major goal of this R21exploratory research grant is to pilot test and refine an adapted intervention that teaches resourcefulness skills to women dementia caregivers (CGs). The resourcefulness training (RT) intervention has strong theoretical grounding and there is beginning empirical evidence for its effectiveness in reducing stress, minimizing depressive symptoms, and promoting optimal quality of life for populations other than women dementia CGs. The proposed 2-year pilot study will provide qualitative and quantitative data for determining the necessity, acceptability, feasibility, fidelity, safety, and effectiveness of two innovatively designed methods of RT within the context of a small partially randomized preference trial with 120 women dementia CGs. In RT, the two methods to be tested (expressive writing, EW) and verbal disclosure, VD) are used for practicing / reinforcing resourcefulness skills. However, because research has shown that both EW and VD may be effective stress-reducing techniques, we will also examine those effects without RT. We propose that RT reinforced by EW or VD will provide CGs with essential skills for managing stress and preserving mental and physical health while providing care for their elderly care recipients (CRs). Quantitative data on measures of stress, cognitions, emotions, resourcefulness, and mental and physical health will be collected at baseline (T1) and at 1 week (T2) and 6 weeks (T3) post-intervention. Qualitative data will be obtained from CG journal (EW) / recordings (VD), data collector's field notes, follow-up logs, etc. Baseline Resourcefulness Scale (RS) scores and qualitative data from journals / recordings will be used to examine the necessity of the RT. CGs will be randomized into "random" or "choice" conditions and their data (i.e., journals, recordings, field notes, follow-up logs, participation / retention logs) will be examined to determine acceptability, feasibility, and fidelity of RT. Safety of RT will be monitored for adverse events and reports of psychological distress or elder abuse. Effectiveness of RT-EW and RT-VD (compared to EW and VD without RT) will be examined in relation to specific outcomes at time intervals suggested by Resourcefulness Theory and in relation to factors within the CG, CR, and CG situation. Most importantly, we will learn whether giving CGs a choice of EW or VD with or without RT improves their outcomes. Conclusions drawn from the critical examination of the six intervention parameters will inform further refinement and testing of RT for dementia CGs in a full scale randomized, controlled trial. Once established, such interventions will be useful in promoting optimal, healthy functioning among dementia CGs so that they can continue to provide adequate care for their CRs without sacrificing their own health and avoid placement of the elder in a long term care facility. PUBLIC HEALTH RELEVANCE Dementia is one of the greatest challenges facing elders in the U.S. and the public health significance of dementia caregiving has permeated the scientific and lay literature for decades. Despite the number of clinical trials testing interventions for reducing caregiver stress, none have tested methods of teaching them resourcefulness skills and none have allowed caregivers to choose a preferred intervention. Resourcefulness Training, the intervention to be tested in this study, is a cost-effective, easy-to-use method for reducing caregiver stress and promoting their optimal mental health.