Proactive Primary Dementia Care

描述（由申请人提供）：痴呆是一种与年龄相关的临床综合征，其特征是记忆和其他认知能力的不可逆丧失或下降，是一个日益严重的健康问题。2008年，估计有520万美国人患有阿尔茨海默病（AD），占所有痴呆症的70%左右;到2050年，仅AD患病率预计将增加到1100多万。照顾痴呆症患者的家庭成员往往会遭受不利的健康后果。初级保健医生通常是第一个接触老年人与记忆丧失的投诉和他们的家人，但大量的证据表明，医生面临着许多限制，提供全面的痴呆症护理。最近的几项旨在加强这些患者及其家庭的初级保健的随机对照试验发现了积极的结果;然而，没有一项试验成功地持续到研究期之后，也没有一项试验在以社区为基础的初级保健环境中得到复制。因此，这项发展性研究的长期目标是实施循证护士-执业医师指导的痴呆症护理干预，与指定地理区域的一组或多组初级保健医生联系，以最大限度地提高新发或近期诊断的AD或其他年龄相关性痴呆症患者及其家庭护理人员的健康相关结局。拟议的12个月干预措施，主动初级痴呆症护理（PPDC），是建立在逐步降低的压力阈值模型的痴呆症护理，并利用循证非药理学协议沿着与医生一起药物和合并症监测。具体目标和主要假设是：具体目标#1：确定PPDC对患者及其主要家庭照顾者健康相关结局的初步疗效。患者特异性假设：与对照组患者相比，接受PPDC的患者将显示出减少或更稳定的神经精神症状，以及改善或更稳定的自我报告的生活质量。护理人员特定假设：与对照组的照顾者相比，接受PPDC的照顾者将显示出减少或更稳定的抑郁症状和负担，以及增加或更稳定的管理痴呆症的自我效能。具体目标#2：确定医生、患者和护理人员对PPDC的可接受性。具体目标3：审查PPDC的初步财务可持续性。将从两个初级保健实践场所招募总共35名患者-护理人员二人组参与PPDC;将从两个不同的实践场所招募35名二人组作为对照组，他们将与研究人员一起接收和审查有关痴呆症和社区资源的教育材料，并鼓励他们寻求进一步的信息和帮助。公共卫生相关性：痴呆症是一个比例迅速增长的公共卫生问题。痴呆症特有的认知和行为症状通常会给患者及其家人带来极大的压力。在这项发展研究中提出的干预措施是基于大量的证据表明，初级保健医生需要其他医疗保健从业人员的帮助，以满足患者和家庭的需求，从诊断开始。需要以证据为基础，理论为基础的干预措施，以加强初级保健环境中的痴呆症护理，从诊断时起或在诊断后尽快采取积极主动的方式，以避免或减轻患者及其家庭照顾者的不良健康相关结果。

DESCRIPTION (provided by applicant): Dementia, an age-associated clinical syndrome characterized by irreversible loss or decline in memory and other cognitive abilities, is a growing health problem. In 2008, an estimated 5.2 million Americans have Alzheimer's disease (AD), which comprises about 70 percent of all dementia; AD prevalence alone is projected to increase to more than 11 million by 2050. Family members caring for people with dementia often suffer adverse health consequences. Primary care physicians are usually the first contact for older people with memory loss complaints and their families, but substantial evidence shows that physicians face numerous constraints to providing comprehensive dementia care. Several recent randomized controlled trials to enhance primary care for these patients and families have found positive results; however, none has been successfully sustained beyond the study period or replicated in community-based primary care settings. Accordingly, the long range goal of this developmental study is to implement an evidence-based nurse-practitioner guided dementia care intervention, linked to one or more groups of primary care physicians in a defined geographic area, to maximize health-related outcomes in patients with new or recently diagnosed AD or other age-associated dementia and their family caregivers. The proposed 12-month intervention, Proactive Primary Dementia Care (PPDC), is grounded in the Progressively Lowered Stress Threshold model of dementia care, and utilizes evidence-based nonpharmacologic protocols along with medication and comorbidity monitoring in tandem with physicians. Specific aims and major hypotheses are: Specific Aim #1: Determine the preliminary efficacy of PPDC on health-related outcomes in patients and their primary family caregivers. Patient-specific hypotheses: Patients receiving PPDC will show reduced or more stabilized neuropsychiatric symptoms, and improved or more stabilized self-reported quality of life, compared to control group patients. Caregiver-specific hypotheses: Caregivers receiving PPDC will show reduced or more stabilized depressive symptoms and burden, and increased or more stabilized self-efficacy for managing dementia, compared to caregivers in the control group. Specific Aim #2: Determine the acceptability of PPDC to physicians, patients, and caregivers. Specific Aim #3: Examine the preliminary financial sustainability of PPDC. A total of 35 patient-caregiver dyads will be recruited to participate in PPDC from two primary care practice sites; 35 dyads will be recruited for the control group from two different practice sites, and they will receive and review with study personnel educational material about dementia and community resources, and will be encouraged to seek further information and help as they see fit. PUBLIC HEALTH RELEVANCE: Dementia is a public health problem of rapidly growing proportions. Cognitive and behavioral symptoms characteristic of dementia are often extremely stressful to patients and their families. The intervention proposed in this developmental study is based on substantial evidence that primary care physicians require assistance from other health care practitioners to meet the needs of patients and families from the point of diagnosis onward. Evidence-based, theoretically grounded interventions are needed to enhance dementia care in the primary care setting, in a proactive fashion from the time of diagnosis or as soon as possible thereafter, to avoid or alleviate poor health-related outcomes in patients and their family caregivers.