R01AG085177

Adapting the CHATO communication intervention for diverse nursing home communities - dementia is most prevalent in Black and Hispanic older adults who are increasingly cared for in nursing homes (NHS).

Staff shortages and lack of dementia care skills limit care quality, especially in NHS with high proportions of ethnoracially diverse residents.

Care for persons living with dementia (PLWD) in NHS is complicated by behavioral and psychological symptoms of dementia (BPSD) when residents cannot express unmet physical and psychosocial needs.

BPSD increase staff stress and time to complete care, contribute to staff turnover and injury, and lead to use of inappropriate psychoactive medication to control resident BPSD.

Our team demonstrated that BPSD occur when staff use elderspeak (speech that sounds like baby talk).

Elderspeak features inappropriately intimate terms of endearment (diminutives such as “honey”), belittling pronoun substitutions that imply dependence (“we” need a bath), and harsh task-oriented commands (“sit down”).

Elderspeak conveys a message of disrespect and incompetence to PLWD who react with withdrawal or BPSD.

Our prior research established that elderspeak use more than doubled the occurrences of BPSD responses in NH residents with dementia.

We later confirmed that the three-session Changing Talk (CHAT) communication education intervention reduced staff elderspeak use that significantly reduced resident BPSD.

CHAT in online format (CHATO) has demonstrated communication knowledge and confidence gains and is currently being tested in a national clinical trial.

However, NHS serving higher proportions of diverse residents have not shown interest in participation, despite having more frequent and serious care deficiencies including higher rates of BPSD and antipsychotic medication use.

Research has established that tailoring and intensification approaches are often needed for interventions across care settings to reduce care disparities.

We will first engage staff in six NHS caring for diverse residents and our expert stakeholder panel to adapt the current CHATO intervention using the ADAPT framework to increase cultural competency.

We will test the adapted intervention (CHATO-I) in a waitlist-controlled trial in 40 NHS that care for high proportions of minority residents (<75% White, non-Hispanic).

NHS will be randomized to four groups and staff will complete the adapted intervention with high-intensity implementation support (i.e., weekly meetings, troubleshooting, expert consultation, leadership/champion training, incentives, tablets, and technology support).

We will evaluate feasibility and acceptability (participation and completion rates) and use mixed modeling of electronic medical record data to assess preliminary effects on resident BPSD and psychoactive medication use.

The NIA health disparities framework will guide adaptation and testing in NHS serving diverse residents with a goal of reducing health disparities (BPSD and psychoactive medication use), addressing national plan to address Alzheimer’s disease goals, NIA’s milestones for nonpharmacological interventions, and the National Academy imperative to improve NH care equity through culturally tailored interventions.

University Of Kansas Medical Center Research Institute

TO ENCOURAGE BIOMEDICAL, SOCIAL, AND BEHAVIORAL RESEARCH AND RESEARCH TRAINING DIRECTED TOWARD GREATER UNDERSTANDING OF THE AGING PROCESS AND THE DISEASES, SPECIAL PROBLEMS, AND NEEDS OF PEOPLE AS THEY AGE. THE NATIONAL INSTITUTE ON AGING HAS ESTABLISHED PROGRAMS TO PURSUE THESE GOALS. THE DIVISION OF AGING BIOLOGY EMPHASIZES UNDERSTANDING THE BASIC BIOLOGICAL PROCESSES OF AGING. THE DIVISION OF GERIATRICS AND CLINICAL GERONTOLOGY SUPPORTS RESEARCH TO IMPROVE THE ABILITIES OF HEALTH CARE PRACTITIONERS TO RESPOND TO THE DISEASES AND OTHER CLINICAL PROBLEMS OF OLDER PEOPLE. THE DIVISION OF BEHAVIORAL AND SOCIAL RESEARCH SUPPORTS RESEARCH THAT WILL LEAD TO GREATER UNDERSTANDING OF THE SOCIAL, CULTURAL, ECONOMIC AND PSYCHOLOGICAL FACTORS THAT AFFECT BOTH THE PROCESS OF GROWING OLD AND THE PLACE OF OLDER PEOPLE IN SOCIETY. THE DIVISION OF NEUROSCIENCE FOSTERS RESEARCH CONCERNED WITH THE AGE-RELATED CHANGES IN THE NERVOUS SYSTEM AS WELL AS THE RELATED SENSORY, PERCEPTUAL, AND COGNITIVE PROCESSES ASSOCIATED WITH AGING AND HAS A SPECIAL EMPHASIS ON ALZHEIMER'S DISEASE. SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM: TO EXPAND AND IMPROVE THE SBIR PROGRAM, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, TO INCREASE SMALL BUSINESS PARTICIPATION IN FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION. SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM: TO STIMULATE AND FOSTER SCIENTIFIC AND TECHNOLOGICAL INNOVATION THROUGH COOPERATIVE RESEARCH DEVELOPMENT CARRIED OUT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO FOSTER TECHNOLOGY TRANSFER BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION.

93.866 - Aging Research

National Institute on Aging (NIA) [HHS - NIH]

Kansas City, Kansas 66160 United States

Single Zip Code

Dementia Care and Caregiver Support Intervention Research (R01 Clinical Trial Required) (PAR-21-307)

Amendment Since initial award the total obligations have increased 361% from $772,273 to $3,562,955.