NRC:Improving Healthcare for Cognitively Impaired Elders and Their Caregivers (RDAD&APNs)

NRC: Improving Healthcare for Cognitively Impaired Elders and Their Caregivers

An multi-stage mixed-method design will be employed to obtain both qualitative and quantitative data to address two study aims: (1) Evaluate and refine the delivery Reducing Disabilities in Alzheimer's Disease (RD- AD) training to advanced practice nurses and (2) Evaluate and refine the implementation of RD-AD by advanced practice nurses in their medical settings.

Study Overview

• Status: Unknown
• Conditions: Alzheimer Disease; Nurse Training
• Intervention / Treatment: Behavioral: RDAD Training

Detailed Description

Two waves of APNs (25 each wave/total 50) will receive RDAD training and be queried pre and post- training using both qualitative and quantitative procedures to determine: (1) Is RDAD training successfully received by advanced practice nurses? (2) Do they report it as relevant to improving the care they deliver to persons with Alzheimer's Disease and Related Dementias (ADRD)? (3) Does RDAD training of advanced practice nurses improve their level of knowledge about ADRD, their skills in providing ADRD care, and their level of confidence in providing this care?

A subset of advanced practice nurses (5 per wave, total of 10) will be recruited to implement RDAD as part of their ongoing care of persons with ADRD.

• Study Type: Interventional
• Enrollment (Anticipated): 50
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Christine A Coulter, Ph.D.; Phone Number: 206-685-9169; Email: cac76@uw.edu
• Study Contact Backup: Name: Amy L Cunningham, M.S.; Phone Number: 206-616-5550; Email: amoore@uw.edu

Study Locations

• United States
  • Washington
    • Seattle, Washington, United States, 98195
      • Recruiting
      • University of Washington
      • Contact: Amy Moore Cunningham, MS; Phone Number: 206-616-5550; Email: amoore@u.washington.edu
      • Principal Investigator: Linda Teri, Ph.D.

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Licensed by the Washington state Department of Health as an Advanced Registered Nurse Practitioner (ARNP),
• Hold a board certification as a Gerontological Nurse Practitioner, Adult Nurse Practitioner, or Family Nurse Practitioner,
• Work at least half time (0.50 FTE) in a clinical setting (primary care, internal medicine, sub-specialty, medical home), with a panel consisting of over 25% of patients over 65 years of age,
• Have no expectation for termination over the course of the study; and
• Agree to participate in all phases of the RDAD translational program.

Exclusion Criteria:

• NA

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: RDAD training to APNs; Half-day workshop to provide APNs with all skills necessary to conduct RDAD in their clinical settings. A subset of the trained APNs will implement RDAD as part of their ongoing care of persons with ADRD.

Behavioral: RDAD Training; An interactive processes of lecture, role-play, and discussion, APNs will have the opportunity to dissect all phases of RDAD to insure they understand the objectives, can enact the program, and feel confident they can problem-solve situations that arise. APNs will receive materials to insure they are knowledgeable about ADRD symptoms, behavior management techniques, and exercise safety.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Physician Confidence in Dementia Care Skills	A 12-item self-report measure (administered to ARNPs) designed to measure perception of ability to address the care needs of patients with ADRD.	Change from baseline score at 2 months
Sense of Competence in Dementia	A 17-item questionnaire covering 4 domains: job satisfaction, attitude towards dementia, work experience, and level of dementia knowledge.	Change from baseline score at 2 months
Dementia Attitudes Scale	A 20-item scale to measures attitudes towards dementia with a two-factor structure; "dementia knowledge" and "social comfort".	Change from baseline score at 2 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Focus Group Questions	Questions to determine satisfaction with a acceptability of RDAD	At 2 months
Implementation Questions	Questions to determine Acceptability of RDAD	At 2 months

Collaborators and Investigators

• Sponsor: University of Washington
• Investigators: Principal Investigator: Linda Teri, Ph.D., University of Washington

Publications and helpful links

General Publications

• Teri L, Gibbons LE, McCurry SM, Logsdon RG, Buchner DM, Barlow WE, Kukull WA, LaCroix AZ, McCormick W, Larson EB. Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial. JAMA. 2003 Oct 15;290(15):2015-22. doi: 10.1001/jama.290.15.2015.
• Kukull WA, Higdon R, Bowen JD, McCormick WC, Teri L, Schellenberg GD, van Belle G, Jolley L, Larson EB. Dementia and Alzheimer disease incidence: a prospective cohort study. Arch Neurol. 2002 Nov;59(11):1737-46. doi: 10.1001/archneur.59.11.1737.
• Small GW, Rabins PV, Barry PP, Buckholtz NS, DeKosky ST, Ferris SH, Finkel SI, Gwyther LP, Khachaturian ZS, Lebowitz BD, McRae TD, Morris JC, Oakley F, Schneider LS, Streim JE, Sunderland T, Teri LA, Tune LE. Diagnosis and treatment of Alzheimer disease and related disorders. Consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer's Association, and the American Geriatrics Society. JAMA. 1997 Oct 22-29;278(16):1363-71.
• Brodaty H, Arasaratnam C. Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. Am J Psychiatry. 2012 Sep;169(9):946-53. doi: 10.1176/appi.ajp.2012.11101529. Erratum In: Am J Psychiatry. 2013 Feb 1;170(2):227.
• Koch T, Iliffe S; Evidem Programme. The role of primary care in the recognition of and response to dementia. J Nutr Health Aging. 2010 Feb;14(2):107-9. doi: 10.1007/s12603-010-0021-1. No abstract available.
• Bruce DG, Paley GA, Nichols P, Roberts D, Underwood PJ, Schaper F. Physical disability contributes to caregiver stress in dementia caregivers. J Gerontol A Biol Sci Med Sci. 2005 Mar;60(3):345-9. doi: 10.1093/gerona/60.3.345.
• Mohamed S, Rosenheck R, Lyketsos CG, Schneider LS. Caregiver burden in Alzheimer disease: cross-sectional and longitudinal patient correlates. Am J Geriatr Psychiatry. 2010 Oct;18(10):917-27. doi: 10.1097/JGP.0b013e3181d5745d.
• Tun SM, Murman DL, Colenda CC. Concurrent validity of neuropsychiatric subgroups on caregiver burden in Alzheimer disease patients. Am J Geriatr Psychiatry. 2008 Jul;16(7):594-602. doi: 10.1097/JGP.0b013e318173f5fc.
• Gaugler JE, Duval S, Anderson KA, Kane RL. Predicting nursing home admission in the U.S: a meta-analysis. BMC Geriatr. 2007 Jun 19;7:13. doi: 10.1186/1471-2318-7-13.

Helpful Links

• Medicare data claims data Baltimore, MD
• Dementia and its implications for public health 2006

Study record dates

Study Major Dates

• Study Start (Actual): February 1, 2018
• Primary Completion (Anticipated): October 1, 2018
• Study Completion (Anticipated): October 1, 2018

Study Registration Dates

• First Submitted: September 14, 2017
• First Submitted That Met QC Criteria: September 15, 2017
• First Posted (Actual): September 21, 2017

Study Record Updates

• Last Update Posted (Actual): May 15, 2018
• Last Update Submitted That Met QC Criteria: May 9, 2018
• Last Verified: May 1, 2018

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurocognitive Disorders; Neurodegenerative Diseases; Dementia; Tauopathies; Alzheimer Disease
• Other Study ID Numbers: STUDY00003731

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No