Gerontological Nursing Interventions Research Center (GNIRC)

Title: Treatment Strategies for ADRA-related Anxiety in ALFs
Principal Investigator : Kathleen C. Buckwalter, PhD, RN, FAAN
Study Site: University of Iowa

Abstract
The overall aim of this pilot study is to set the stage for subsequent testing of the effectiveness of a multi-phase management strategy for persons with dementia-related anxiety and agitation, which serves to enhance their daily function and delay nursing home placement. This Phase I study begins the process by examining and refining data collection instruments, procedures, and inclusion criteria; evaluating the acceptability and usefulness of proposed screening and outcome measures; and exploring the role of genetic risk factors in the development of late life anxiety. Phase I will also allow for modifications of the PLST intervention for application in assisted living facilities (ALFs), and development of a Caregiver Manual for use in Phase II. Phase II and III treatment strategies involve systematic evaluation and intervention plans that optimize care from a nursing, medical, environmental and pharmacologic perspective. These approaches are based on research demonstrating that environmental stressors, cognitive state, behavioral symptoms and caregiver burden influence loss of independent living status. Hence, it is essential to address most if not all of these factors to enhance function in a way that may delay institutionalization. Thus, 'multi-modal' treatment interventions, such as the one proposed by the PI in her renewed program of research, may achieve better outcomes. Four specific aims guide this pilot study:

•  Examine the feasibility of the proposed inclusion/exclusion criteria and data collection methods/procedures. Refine criteria and procedures for use in future studies

•  Determine the acceptability and usefulness of the proposed psychiatric, cognitive, functional, and biologic (salivary cortisol) measures in ALF residents, and examine their relationship to anxiety and agitation in this population.

•  Explore the role of genetic risk factors for the development late life anxiety, and for possible inclusion in Phase II and III studies to examine treatment response to interventions.

•  Modify the Progressively Lowered Stress Threshold (PLST) intervention for use in ALFs., and prepare a Caregiver Manual based on this intervention for use in Phase II.

This 1-year pilot allows for feasibility evaluation and genetic testing in preparation for future effectiveness research that build upon the PI's prior work with the PLST model, but will test it in combination with other intervention strategies, in a new setting, with diverse outcomes that focus on the care recipient rather than caregivers.