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Trial to Reduce Antimicrobial Use in Nursing home residents with Alzheimer's disease and other Dementias (TRAIN-AD)

Award Number: R37AG032982
ORGANIZATION: NATIONAL INSTITUTE ON AGING
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/01/2009
PERIOD OF PERFORMANCE END DATE: 12/31/2027

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Trial to Reduce Antimicrobial Use in Nursing home residents with Alzheimer's disease and other Dementias (TRAIN-AD) - The advanced stage of Alzheimer’s disease and other dementias is characterized by the onset infections, which prior work suggests are widely mismanaged. Antimicrobials are extensively prescribed, most often without evidence to support a bacterial infection. Antimicrobial exposure is the main factor leading to multidrug- resistant organisms (MDROs); a growing public health threat. Moreover, the benefits of antimicrobials remain unclear for patients with advanced dementia, for whom infections are often a terminal event and comfort is most commonly the goal of care. In 2015, our group completed a prospective study of nursing home (NH) residents with advanced dementia, the Study of Pathogen Resistance and Exposure to Antimicrobials in Dementia (SPREAD) (parent NIH R01 for this competing renewal). Antimicrobials were prescribed for 72% of suspected infections, but only 44% episodes met guideline-based criteria for treatment. Criteria were more likely to be met when proxies were counseled about antimicrobials. Two-thirds of residents were colonized with MDROs. Antimicrobial use was the major risk factor for MDRO acquisition. Motivated by these findings, the PIs conducted a pilot study (NIH R21) of an intervention to improve management of suspected urinary (UTIs) and lower respiratory tract infections (LRIs). With this foundation, the goal of this proposal, TRAIN-AD (Trial to Reduce Antimicrobial Use In Nursing home residents with Alzheimer’s disease and other Dementias), is to conduct a cluster randomized controlled trial of the intervention among 480 residents with advanced dementia (N=240/arm) in 16 Boston-area NHs (N=8/arm). The intervention has two main components: 1. Provider Training: In-person training, on-line course, management algorithms, and prescribing feedback, and 2. Proxy Education: booklet. Unlike most antimicrobial stewardship programs, the intervention merges best practices in infectious diseases and palliative care, and targets a unique population for whom the need to improve infection management is particularly compelling. The Aims are to compare the following 12-month outcomes between residents in the intervention and control arms (usual care) related to suspected UTIs and LRIs: Aim 1. total number of antimicrobial courses/person-year (10 outcome); Aim 2. number of antimicrobial courses prescribed when guideline-based criteria for treatment are absent/person-year (20 outcome), and Aim 3. i. advance care planning about infection management, and ii. burdensome procedures/person-days used to evaluate these episodes/person-year (20 outcomes). IMPLICATIONS: Prior work by our group has demonstrated a critical need to improve the quality of care for suspected infections in advanced dementia patients. A cluster RCT of an intervention to optimize infection management is the next logical step. This proposal addresses 3 federal research priorities: Alzheimer’s disease, palliative care, and antibiotic stewardship. Thus, it has the potential to make clinical and policy-relevant contributions by promoting patient-centered end-of-life care for millions of Americans with advanced dementia, and reducing the growing public health threat of MDROs in NHs.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $774,752 )
2025	2025	HEBREW REHABILITATION CENTER	1200 CENTRE ST	ROSLINDALE	MA	02131	SUFFOLK	USA	Aging Research	001	13	7/22/2025	NON-COMPETING CONTINUATION	$63,245
2025	2025	HEBREW REHABILITATION CENTER	1200 CENTRE ST	ROSLINDALE	MA	02131	SUFFOLK	USA	Aging Research	000	13	12/20/2024	NON-COMPETING CONTINUATION	$711,507
														Subtotal = $774,752

Issue Date FY: 2024 ( Subtotal = $810,146 )
2024	2024	HEBREW REHABILITATION CENTER	1200 CENTRE ST	ROSLINDALE	MA	02131	SUFFOLK	USA	Aging Research	001	12	5/6/2024	NON-COMPETING CONTINUATION	$81,016
2024	2024	HEBREW REHABILITATION CENTER	1200 CENTRE ST	ROSLINDALE	MA	02131	SUFFOLK	USA	Aging Research	000	12	12/14/2023	NON-COMPETING CONTINUATION	$729,130
														Subtotal = $810,146

Issue Date FY: 2023 ( Subtotal = $758,262 )
2023	2023	HEBREW REHABILITATION CENTER	1200 CENTRE ST	ROSLINDALE	MA	02131	SUFFOLK	USA	Aging Research	002	11	6/29/2023	EXTENSION WITH OR WITHOUT FUNDS	$49,973
2023	2023	HEBREW REHABILITATION CENTER FOR AGED, INC.	1200 CENTRE ST	BOSTON	MA	02131	SUFFOLK	USA	Aging Research	000	11	1/6/2023	EXTENSION WITH OR WITHOUT FUNDS	$758,262
2023	2021	HEBREW REHABILITATION CENTER	1200 CENTRE ST	ROSLINDALE	MA	02131	SUFFOLK	USA	Aging Research	001	10	6/29/2023	NON-COMPETING CONTINUATION	-$49,973
														Subtotal = $758,262

Issue Date FY: 2021 ( Subtotal = $172,300 )
2021	2021	HEBREW REHABILITATION CENTER FOR AGED, INC.	1200 CENTRE ST	BOSTON	MA	02131	SUFFOLK	USA	Aging Research	000	10	3/2/2021	NON-COMPETING CONTINUATION	$172,300
														Subtotal = $172,300

Issue Date FY: 2020 ( Subtotal = $720,084 )
2020	2020	HEBREW REHABILITATION CENTER FOR AGED, INC.	1200 CENTRE ST	BOSTON	MA	02131	SUFFOLK	USA	Aging Research	001	9	1/22/2020	NON-COMPETING CONTINUATION	$72,009
2020	2020	HEBREW REHABILITATION CENTER FOR AGED, INC.	1200 CENTRE ST	BOSTON	MA	02131	SUFFOLK	USA	Aging Research	000	9	1/6/2020	NON-COMPETING CONTINUATION	$648,075
														Subtotal = $720,084

Issue Date FY: 2019 ( Subtotal = $826,001 )
2019	2019	HEBREW REHABILITATION CENTER FOR AGED, INC.	1200 CENTRE ST	BOSTON	MA	02131	SUFFOLK	USA	Aging Research	000	8	11/20/2018	NON-COMPETING CONTINUATION	$826,001
														Subtotal = $826,001

Issue Date FY: 2018 ( Subtotal = $834,838 )
2018	2018	HEBREW REHABILITATION CENTER FOR AGED, INC.	1200 CENTRE ST	BOSTON	MA	02131	SUFFOLK	USA	Aging Research	002	7	4/27/2018	NON-COMPETING CONTINUATION	$0
2018	2018	HEBREW REHABILITATION CENTER FOR AGED, INC.	1200 CENTRE ST	BOSTON	MA	02131	SUFFOLK	USA	Aging Research	001	7	4/12/2018	NON-COMPETING CONTINUATION	$83,484
2018	2018	HEBREW REHABILITATION CENTER FOR AGED, INC.	1200 CENTRE ST	BOSTON	MA	02131	SUFFOLK	USA	Aging Research	000	7	12/22/2017	NON-COMPETING CONTINUATION	$751,354
														Subtotal = $834,838

Issue Date FY: 2017 ( Subtotal = $834,102 )
2017	2017	HEBREW REHABILITATION CENTER FOR AGED, INC.	1200 CENTRE ST	BOSTON	MA	02131	SUFFOLK	USA	Aging Research	001	6	6/8/2017	COMPETING CONTINUATION	$150,140
2017	2017	HEBREW REHABILITATION CENTER FOR AGED, INC.	1200 CENTRE ST	BOSTON	MA	02131	SUFFOLK	USA	Aging Research	000	6	12/23/2016	COMPETING CONTINUATION	$683,962
														Subtotal = $834,102

Grand Total All Awards = $5,730,485

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Trial to Reduce Antimicrobial Use in Nursing home residents with Alzheimer's disease and other Dementias (TRAIN-AD)

Award Number: R37AG032982

ORGANIZATION: NATIONAL INSTITUTE ON AGING

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/01/2009

PERIOD OF PERFORMANCE END DATE: 12/31/2027

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