Relevance: The overall goal of this program of study is to improve assessment and treatment of discomfort in people with advanced dementia. This study is a test of two interventions designed to meet that goal. Description: The purpose of this competing continuation is to compare the effect of the Serial Jrial intervention plus Discomfort Burden Reduction intervention (STI plus DBR) to the STI alone on five outcomes: discomfort, behavioral symptoms, stress (cortisol), discomfort comorbidities, and use of acute care services. The STI was developed to assist in the differential diagnosis and treatment process: the focus is on early identification and correction of problems associated with discomfort. Our recent CT demonstrated that use of the STI was effective in decreasing discomfort. Despite the effectiveness of the STI, we found limitations in directing treatmentthat sustained improvements in comfort. Thus, we have developed the DBR intervention to supplement the STI. The DBR focuses on minimizing the clinically preventable and treatable burden of discomfort over a longer time period. We will examine group differences in process variables (scope of assessment,scope of treatment, stabilization of treatment, treatments added, treatment stopped, static cares and reactive cares); and plan to evaluate the efficacy of interventions in relation to dose. In addition, we propose to examine the effect of organizational characteristics on care received by measuring the interactionof staffing level, turnover level, and nursing home culture on group differences in resident care and resident outcomes. A two group repeated measures experimental design with double blinding procedures will be used to compare the two study conditions. Twelve long-term care facilities will be stratified based on size, location, and % Medicaid reimbursement, and then randomly assigned to one of the groups. A total sample of 122 (61 subjects/group) will provide at least 80% power to detect an effect size of 0.63 between any two groups. Use of the STI will be initiated when a subject exhibits behavioral/verbalsymptoms of possible discomfort that are not ameliorated by basic care interventions. Nurses caring for subjects in the STI plus DBR group will initiate the DBR based upon information regarding effective treatment gained by using the STI. Inferential analyses planned include: mixed models for repeated measures, analysis of variance, Chi square and regression models for testing dose response.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
5R01NR007765-05
Application #
7342097
Study Section
Nursing Science: Adults and Older Adults Study Section (NSAA)
Program Officer
Wasserman, Joan
Project Start
2007-02-01
Project End
2010-11-30
Budget Start
2007-12-01
Budget End
2008-11-30
Support Year
5
Fiscal Year
2008
Total Cost
$491,051
Indirect Cost
Name
University of Wisconsin Milwaukee
Department
Type
Schools of Nursing
DUNS #
627906399
City
Milwaukee
State
WI
Country
United States
Zip Code
53201
Kovach, Christine R; Rababa, Mohammad (2014) Using branching simulations in treatment fidelity plans. Res Gerontol Nurs 7:216-23
Kovach, Christine R; Woods, Diana Lynn; Devine, Elizabeth C et al. (2014) Biobehavioral measures as outcomes: a cautionary tale. Res Gerontol Nurs 7:56-65
Kovach, Christine R; Simpson, Michelle R; Joosse, Laura et al. (2012) Comparison of the effectiveness of two protocols for treating nursing home residents with advanced dementia. Res Gerontol Nurs 5:251-63
Simpson, Michelle R; Kovach, Christine R; Stetzer, Frank (2012) Predictors of nonpharmacological and pharmacological treatments stopped and started among nursing home residents with dementia. Res Gerontol Nurs 5:130-7
Kovach, Christine R; Logan, Brent R; Joosse, Laura L et al. (2012) Failure to identify behavioral symptoms of people with dementia and the need for follow-up physical assessment. Res Gerontol Nurs 5:89-93
Kovach, Christine R; Woods, Diana Lynn; Logan, Brent R et al. (2011) Diurnal variation of cortisol in people with dementia: relationship to cognition and illness burden. Am J Alzheimers Dis Other Demen 26:145-50
Pieper, Marjoleine J C; Achterberg, Wilco P; Francke, Anneke L et al. (2011) The implementation of the serial trial intervention for pain and challenging behaviour in advanced dementia patients (STA OP!): a clustered randomized controlled trial. BMC Geriatr 11:12
Kovach, Christine R; Logan, Brent R; Simpson, Michelle R et al. (2010) Factors associated with time to identify physical problems of nursing home residents with dementia. Am J Alzheimers Dis Other Demen 25:317-23
Kovach, Christine R; Noonan, Patricia E; Schlidt, Andrea Matovina et al. (2006) The Serial Trial Intervention: an innovative approach to meeting needs of individuals with dementia. J Gerontol Nurs 32:18-25; quiz 26-7
Kovach, Christine R; Logan, Brent R; Noonan, Patricia E et al. (2006) Effects of the Serial Trial Intervention on discomfort and behavior of nursing home residents with dementia. Am J Alzheimers Dis Other Demen 21:147-55

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