通过以家庭为中心的干预措施减少阿尔茨海默病及相关痴呆症急性病患者的残疾：一项整群随机对照试验的方案（家庭-FFC研究）

Reducing disability via a family centered intervention for acutely ill persons with Alzheimer's disease and related dementias: protocol of a cluster-randomized controlled trial (Fam-FFC study).

作者信息

Boltz Marie, Kuzmik Ashley, Resnick Barbara, Trotta Rebecca, Mogle Jacqueline, BeLue Rhonda, Leslie Douglas, Galvin James E

机构信息

The Pennsylvania State University, College of Nursing, 306 Nursing Sciences Building, University Park, PA, 16802, USA.

University of Maryland School of Nursing, Baltimore, MD, USA.

出版信息

Trials. 2018 Sep 17;19(1):496. doi: 10.1186/s13063-018-2875-1.

DOI:10.1186/s13063-018-2875-1

PMID:30223870

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6142366/

Abstract

BACKGROUND

Hospitalized older persons with Alzheimer's disease and related dementias 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, lack of family involvement and limited staff knowledge of dementia care. We have developed a theory-based intervention, Family centered Function-focused Care, that incorporates an educational empowerment model for family caregivers (FCGs) provided within a social-ecological framework to promote specialized care to patients with dementia during hospitalization and the 60-day post-acute period. Primary aims are to test the efficacy of the intervention in improving physical and cognitive recovery in hospitalized persons living with Alzheimer's disease and related dementias (ADRD) and improving FCG preparedness and experiences.

METHOD

We will implement Family centered Function-focused Care in a cluster-randomized trial of 438 patient/FCG dyads in six hospital units randomized within three hospitals. We hypothesize that patients who receive the intervention will demonstrate better physical function, less delirium occurrence and severity, neuropsychiatric symptoms, and depression compared to those in the control condition (Education-only). We also hypothesize that FCGs enrolled in Family centered Function-focused Care will experience increased preparedness for caregiving, and less strain, burden, and desire to institutionalize, as compared to FCGs the control group. We will also examine the costs and relative cost savings associated with the intervention and will evaluate the cultural appropriateness of Family centered Function-focused Care for families from diverse backgrounds.

DISCUSSION

Our theory-based intervention makes use of real-world applicable approaches in a novel and innovative way to change the paradigm of how we currently look at acute care and post-acute transitions in persons with ADRD.

TRIAL REGISTRATION

ClinicalTrials.gov, ID: NCT03046121 . Registered on 8 February 2017.

摘要

背景

患有阿尔茨海默病及相关痴呆症的住院老年人，由于内在因素、环境、政策以及限制身体和认知活动的护理实践、缺乏家庭参与和护理人员对痴呆症护理知识有限等因素的综合作用，出院后功能下降和护理依赖增加的风险更大。我们开发了一种基于理论的干预措施，即以家庭为中心的功能聚焦护理，该措施在社会生态框架内为家庭护理人员（FCG）纳入了一种教育赋权模式，以促进住院期间及急性后期60天内对痴呆症患者的专门护理。主要目标是测试该干预措施在改善患有阿尔茨海默病及相关痴呆症（ADRD）的住院患者身体和认知恢复方面的疗效，以及改善FCG的准备情况和体验。

方法

我们将在一项整群随机试验中实施以家庭为中心的功能聚焦护理，该试验涉及在三家医院内随机分组的六个医院科室中的438对患者/FCG。我们假设，与接受对照干预（仅教育）的患者相比，接受该干预措施的患者将表现出更好的身体功能、更少的谵妄发生和严重程度、神经精神症状以及抑郁症状。我们还假设，与对照组的FCG相比，参与以家庭为中心的功能聚焦护理的FCG在护理准备方面会有所提高，并且压力、负担和将患者送入机构护理的意愿会降低。我们还将研究与该干预措施相关的成本和相对成本节约情况，并评估以家庭为中心的功能聚焦护理对不同背景家庭的文化适宜性。