University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
University of Washington, School of Nursing, Box 357260, Seattle, WA 98195, USA.
Contemp Clin Trials. 2023 May;128:107143. doi: 10.1016/j.cct.2023.107143. Epub 2023 Mar 7.
Heightened risks of cognitive impairment, disability, and barriers to care among sexual and gender minority (SGM) older adults are well documented. To date, culturally responsive evidence-based dementia interventions for this population do not exist.
This study describes the design of the first randomized controlled trial (RCT) testing a culturally responsive cognitive behavioral and empowerment intervention, Innovations in Dementia Empowerment and Action (IDEA), developed to address the unique needs of SGM older adults living with dementia and care partners.
IDEA is a culturally enhanced version of Reducing Disability in Alzheimer's Disease (RDAD), an efficacious, non-pharmaceutical intervention for people with dementia and care partners. We utilized a staggered multiple baseline design with the goal to enroll 150 dyads randomized into two arms of 75 dyads each, enhanced IDEA and standard RDAD.
IDEA was adapted using findings from the longitudinal National Health, Aging, and Sexuality/Gender study, which identified modifiable factors for SGM older adults, including SGM-specific discrimination and stigma, health behaviors, and support networks. The adapted intervention employed the original RDAD strategies and enhanced them with culturally responsive empowerment practices designed to cultivate engagement, efficacy, and support mobilization. Outcomes include adherence to physical activity, reduction in perceived stress and stigma, and increased physical functioning, efficacy, social support, engagement, and resource use.
IDEA addresses contemporary issues for underserved populations living with dementia and their care partners. Our findings will have important implications for marginalized communities by integrating and evaluating the importance of cultural responsiveness in dementia and caregiving interventions.
性少数群体和跨性别群体（SGM）老年人认知障碍、残疾和护理障碍的风险增加已得到充分记录。迄今为止，针对这一人群的基于文化的循证痴呆症干预措施并不存在。
本研究描述了首个测试针对 SGM 老年痴呆症患者和护理伙伴的具有文化响应能力的认知行为和赋权干预措施的随机对照试验（RCT）的设计，该干预措施称为创新痴呆症赋权和行动（IDEA），旨在满足具有痴呆症的 SGM 老年人的独特需求。
IDEA 是减少阿尔茨海默病残疾（RDAD）的文化增强版本，RDAD 是一种针对痴呆症患者和护理伙伴的有效、非药物干预措施。我们采用交错的多基线设计，目标是招募 150 对随机分为两个 75 对的臂，增强的 IDEA 和标准的 RDAD。
IDEA 是根据纵向国家健康、老龄化和性别研究的结果进行改编的，该研究确定了 SGM 老年人的可修改因素，包括针对 SGM 的歧视和污名、健康行为和支持网络。改编后的干预措施采用了原始的 RDAD 策略，并通过具有文化响应能力的赋权实践对其进行了增强，旨在培养参与、效能和支持动员。结果包括对体育活动的坚持、减少感知到的压力和污名、以及提高身体机能、效能、社会支持、参与度和资源利用。
IDEA 针对患有痴呆症和他们的护理伙伴的服务不足的人群的当代问题。我们的研究结果将通过整合和评估文化响应能力在痴呆症和护理干预中的重要性，对边缘化社区产生重要影响。
