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Ramos K, Shepherd-Banigan M, McDermott C, McConnell ES, Raman SR, Chen D, Der T, Tabriz AA, Boggan JC, Boucher NA, Carlson SM, Joseph L, Sims CA, Ma JE, Gordon AM, Dennis P, Snyder J, Jacobs M, Cantrell S, Gierisch JM, Goldstein KM. Health Care Team Interventions to Reduce Distress Behaviors in Older Adults: A Systematic Review. Clin Gerontol 2024:1-16. [PMID: 38954524 DOI: 10.1080/07317115.2024.2372424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
OBJECTIVES This review examines health care team-focused interventions on managing persistent or recurrent distress behaviors among older adults in long-term residential or inpatient health care settings. METHODS We searched interventions addressing health care worker (HCW) knowledge and skills related to distress behavior management using Ovid MEDLINE, Elsevier Embase, and Ovid PsycINFO from December 2002 through December 2022. RESULTS We screened 6,582 articles; 29 randomized trials met inclusion criteria. Three studies on patient-facing HCW interactions (e.g. medication management, diagnosing distress) showed mixed results on agitation; one study found no effect on quality of life. Six HCW-focused studies suggested short-term reduction in distress behaviors. Quality-of-life improvement or decreased antipsychotic use was not evidenced. Among 17 interventions combining HCW-focused and patient-facing activities, 0 showed significant distress reduction, 8 showed significant antipsychotic reduction (OR = 0.79, 95%CI [0.69, 0.91]) and 9 showed quality of life improvements (SMD = 0.71, 95%CI [0.39, 1.04]). One study evaluating HCW, patient-, and environmental-focused intervention activities showed short-term improvement in agitation. CONCLUSIONS AND CLINICAL IMPLICATIONS Novel health care models combining HCW training and patient management improve patient quality of life, reduce antipsychotic use, and may reduce distress behaviors. Evaluation of intervention's effects on staff burnout and utilization is needed.
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Affiliation(s)
- Katherine Ramos
- Durham Evidence Synthesis Program (ESP) Center, Durham VA Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
- School of Medicine, Duke University, Durham, North Carolina, USA
- Geriatric Research, Education, and Clinical Center (GRECC), Durham VA Health Care System, Durham, North Carolina, USA
- Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Megan Shepherd-Banigan
- Durham Evidence Synthesis Program (ESP) Center, Durham VA Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
- Veterans Affairs Mid-Atlantic Region Mental Illness Research, U.S. Department of Veterans Affairs, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Cara McDermott
- Department of Population Health Sciences, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
- School of Medicine, Duke University, Durham, North Carolina, USA
- Geriatric Research, Education, and Clinical Center (GRECC), Durham VA Health Care System, Durham, North Carolina, USA
- Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA
| | - Eleanor S McConnell
- Geriatric Research, Education, and Clinical Center (GRECC), Durham VA Health Care System, Durham, North Carolina, USA
- Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA
- VA Quality Scholars Program, Durham VA Health Care System, Durham, North Carolina, USA
- Internal Medicine, Duke University School of Nursing, Durham, North Carolina, USA
| | - Sudha R Raman
- Department of Population Health Sciences, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Dazhe Chen
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Tatyana Der
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Joel C Boggan
- School of Medicine, Duke University, Durham, North Carolina, USA
- Durham VA Health Care System, Durham, North Carolina, USA
| | - Nathan A Boucher
- School of Medicine, Duke University, Durham, North Carolina, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
| | - Scott M Carlson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Letha Joseph
- Durham VA Health Care System, Durham, North Carolina, USA
| | - Catherine A Sims
- School of Medicine, Duke University, Durham, North Carolina, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Jessica E Ma
- School of Medicine, Duke University, Durham, North Carolina, USA
- Geriatric Research, Education, and Clinical Center (GRECC), Durham VA Health Care System, Durham, North Carolina, USA
- Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA
| | - Adelaide M Gordon
- Durham Evidence Synthesis Program (ESP) Center, Durham VA Health Care System, Durham, NC, USA
| | - Paul Dennis
- Durham Evidence Synthesis Program (ESP) Center, Durham VA Health Care System, Durham, NC, USA
| | - Julee Snyder
- Durham Evidence Synthesis Program (ESP) Center, Durham VA Health Care System, Durham, NC, USA
| | - Morgan Jacobs
- Durham Evidence Synthesis Program (ESP) Center, Durham VA Health Care System, Durham, NC, USA
| | - Sarah Cantrell
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Jennifer M Gierisch
- Durham Evidence Synthesis Program (ESP) Center, Durham VA Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Karen M Goldstein
- Durham Evidence Synthesis Program (ESP) Center, Durham VA Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
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2
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Chang SH, Yu CL, Chiang MH. Function-Focused Care for Cognitive Impairment Training Among Formal Caregivers in Long-Term Care Facilities in Taiwan: A Cluster Randomized Controlled Trial. J Gerontol Nurs 2024; 50:43-50. [PMID: 38959507 DOI: 10.3928/00989134-20240618-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
PURPOSE To examine behavior changes among formal caregivers in Taiwanese long-term care facilities (LTCFs) after receiving training in function-focused care for cognitive impairment (FFC-CI). METHOD The current study was a clustered randomized controlled trial. Formal caregivers (i.e., RNs and nursing assistants) (N = 98) from four LTCFs were randomly assigned to experimental or control groups. Training was based on four components of FFC-CI. Data were collected four times within 9 months using five observational outcome measurements: Self-Efficacy for Restorative Care (SERCS), Outcome Expectations for Restorative Care Scale (OERCS), Restorative Care Knowledge Scale (RCKS), Restorative Care Behavior Checklist (RCBC), and Job Attitude Scale (JAS). RESULTS Statistically significant changes were noted in each activity of restorative care behavior among the four observational measurements. Results also indicated that job satisfaction was a statistically significant main effect for the experimental group; however, SERCS, OERCS, and RCKS scores were not statistically significant. CONCLUSION To eliminate gaps between translating research outcomes to clinical practice, this study applied a theory-based caring model for caregivers to improve knowledge and skills in caring for older adults with dementia. Caregivers who received training in FFC-CI not only had higher job satisfaction but could also provide specific FFC activities for residents during their daily care. [Journal of Gerontological Nursing, 50(7), 42-50.].
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Jeon YH, Krein L, O’Connor CMC, Mowszowski L, Duffy S, Seeher K, Rauch A. A Systematic Review of Quality Dementia Clinical Guidelines for the Development of WHO's Package of Interventions for Rehabilitation. THE GERONTOLOGIST 2023; 63:1536-1555. [PMID: 36043424 PMCID: PMC10581378 DOI: 10.1093/geront/gnac105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES As part of the WHO Rehabilitation 2030 call for action, the WHO Rehabilitation Programme is developing its Package of Interventions for Rehabilitation (PIR) to support ministries of health around the globe in integrating rehabilitation services into health systems. As a vital step for this PIR development, we conducted a systematic review of clinical practice guidelines (CPGs) for dementia to identify interventions for rehabilitation and related evidence. RESEARCH DESIGN AND METHODS Following WHO Rehabilitation Programme and Cochrane Rehabilitation's methodology, quality CPGs published in English between January 2010 and March 2020 were identified using PubMed, Embase, CINAHL, PEDro, Google Scholar, guideline databases, and professional society websites. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation (II). RESULTS Of the 22 CPGs that met the selection criteria, 6 satisfied the quality evaluation. Three hundred and thirty rehabilitation-related recommendations were identified, mostly concentrated in the areas of cognition, emotion, and carer support. There were many strong interventions, with moderate- to high-quality evidence that could be easily introduced in routine practice. However, major limitations were found both in the quality of evidence and scope, especially in areas such as education and vocation, community and social life, and lifestyle modifications. DISCUSSION AND IMPLICATIONS Further rigorous research is needed to build quality evidence in dementia rehabilitation in general, and especially in neglected areas for rehabilitation. Future work should also focus on the development of CPGs for dementia rehabilitation. A multipronged approach is needed to achieve Universal Health Coverage for dementia rehabilitation.
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Affiliation(s)
- Yun-Hee Jeon
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Luisa Krein
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Claire M C O’Connor
- Centre for Positive Ageing, HammondCare, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Loren Mowszowski
- Brain and Mind Centre & School of Psychology, The University of Sydney, Sydney, Australia
| | - Shantel Duffy
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Katrin Seeher
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Alexandra Rauch
- Rehabilitation Programme, World Health Organization, Geneva, Switzerland
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Beeber AS, Hoben M, Leeman J, Palmertree S, Kistler CE, Ottosen T, Moreton E, Vogelsmeier A, Dardess P, Anderson RA. Developing a toolkit to improve resident and family engagement in the safety of assisted living: Engage-A stakeholder-engaged research protocol. Res Nurs Health 2022; 45:413-423. [PMID: 35538593 DOI: 10.1002/nur.22232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 04/14/2022] [Accepted: 04/23/2022] [Indexed: 01/25/2023]
Abstract
Assisted living (AL) communities are experiencing rising levels of resident acuity, challenging efforts to balance person-centered care-which prioritizes personhood, autonomy, and relationship-based care practices-with efforts to keep residents safe. Safety is a broad-scale problem in AL that encompasses care concerns (e.g., abuse/neglect, medication errors, inadequate staffing, and infection management) as well as resident issues (e.g., falls, elopement, and medical emergencies). Person and family engagement (PFE) is one approach to achieving a balance between person-centered care and safety. In other settings, PFE interventions have improved patient care processes, outcomes, and experiences. In this paper, we describe the protocol for a multiple methods AHRQ-funded study (Engage) to develop a toolkit for increasing resident and family engagement in AL safety. The study aims are to engage AL residents and family caregivers, AL staff, and other AL stakeholders to (1) identify common AL safety problems; (2) prioritize safety problems and identify and evaluate existing PFE interventions with the potential to address safety problems in the AL setting; and (3) develop a testable toolkit to improve PFE in AL safety. We discuss our methods, including qualitative interviews, a scoping review of existing PFE interventions, and stakeholder panel meetings that involved a Delphi priority-setting exercise. In addition to describing the protocol, we detail how we modified the protocol to address the unique challenges of the COVID-19 pandemic. Study findings will result in a toolkit to improve resident and family engagement in the safety of AL that will be tested in future research.
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Affiliation(s)
- Anna S Beeber
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA.,The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Leeman
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Stephanie Palmertree
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Christine E Kistler
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA.,Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Terri Ottosen
- Health Sciences Library, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Elizabeth Moreton
- Health Sciences Library, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Amy Vogelsmeier
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA
| | - Pam Dardess
- Institute for Patient- and Family-Centered Care, McLean, Virginia, USA
| | - Ruth A Anderson
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA
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Paudel A, Galik E, Resnick B, Doran K, Boltz M, Zhu S. Pilot Testing of the Promoting Positive Care Interactions Intervention in Assisted Living. J Gerontol Nurs 2022; 48:17-25. [PMID: 35914082 DOI: 10.3928/00989134-20220629-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The current study aimed to test the feasibility and preliminary efficacy of the Promoting Positive Care Interactions (PPCI) intervention designed to establish positive care interactions between staff and residents in assisted living (AL) using an online approach. PPCI was implemented in one AL community using a single group pre-/posttest design; 17 care staff were recruited from the memory care unit. Delivery, receipt, and enactment of the PPCI were assessed for feasibility. Change in staff outcomes and facility outcomes were examined for preliminary efficacy. The four steps of the PPCI were implemented as intended with 100% staff exposure to education and considerable staff engagement in weekly mentoring sessions. Although there was an improvement in AL environment and policy, no significant changes were observed in staff outcomes. Future testing of the PPCI should include a longer timeline and explore a hybrid model that includes online education and in-person mentoring and coaching of staff to improve care interactions. [Journal of Gerontological Nursing, 48(8), 17-25.].
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6
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Burley CV, Burns K, Lam BCP, Brodaty H. Nonpharmacological approaches reduce symptoms of depression in dementia: A systematic review and meta-analysis. Ageing Res Rev 2022; 79:101669. [PMID: 35714853 DOI: 10.1016/j.arr.2022.101669] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/09/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Depression is a common psychological symptom associated with dementia. Pharmacological approaches are often used despite two large negative trials of efficacy. This meta-analysis examines nonpharmacological (i.e., psychosocial) approaches for symptoms of depression in people living with dementia and reports statistical and clinical significance. METHODS Relevant studies published between 2012 and 2020 were sourced by searching electronic databases: MEDLINE, EMBASE, PsychINFO, Social Work Abstracts and the Cochrane Central Register of Controlled Trials. Studies were assessed for methodological quality. Random-effects meta-analysis was performed to calculate a pooled effect size (ES) and 95% confidence intervals (CI). RESULTS Overall, 37 nonpharmacological studies were identified including 2,636 participants. The mean quality rating was high (12/14, SD=1.4). Meta-analysis revealed that nonpharmacological approaches were significantly associated with reduced symptoms of depression with a medium effect size (ES=-0.53, 95%CI [-0.72, -0.33], p < 0.0001). There was considerable heterogeneity between studies. Meta-regression revealed this was not driven by intervention type or setting (residential versus community). CONCLUSIONS Nonpharmacological approaches such as reminiscence, cognitive stimulation/ rehabilitation, therapeutic, music-based approaches and education/ training, have the potential to reduce symptoms of depression in dementia.
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Affiliation(s)
- Claire V Burley
- Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia.
| | - Kim Burns
- Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Ben C P Lam
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Henry Brodaty
- Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia.
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Resnick B, Boltz M, Galik E, Kuzmik A, Ellis J, Wells C, Zhu S. Testing Function Focused Care for Acute Care using the Evidence Integration Triangle: Protocol description. Res Nurs Health 2022; 45:300-313. [PMID: 35274750 PMCID: PMC9064936 DOI: 10.1002/nur.22223] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 11/09/2022]
Abstract
This manuscript provides the protocol for a National Institute of Aging-funded cluster randomized clinical trial that focuses on helping nurses in acute care to engage patients with dementia in physical activity while hospitalized using an approach referred to as function-focused care. Physical activity is defined as bodily movement produced by skeletal muscles resulting in the expenditure of energy and includes functional tasks such as bathing and dressing, leisure activity, ambulation, and moderate and vigorous intensity physical activity such as dancing, bike riding, or walking upstairs. The development of Function Focused Care for Acute Care (FFC-AC) was based on the Social Ecological Model and Social Cognitive Theory and includes four steps: (1) Environment and Policy Assessments; (2) Education; (3) Establishing Patient Goals; and (4) Mentoring and Motivating of Staff (all levels of nursing staff), Patients, and Families. Function-focused care activities include motivating older patients to participate in bed mobility; personal care activities such as bathing, dressing, ambulating as they are able; and other types of physical activities. The integration of the intervention among the nurses on the units is guided by the Evidence Integration Triangle (EIT), which includes the participation of a stakeholder team and practical outcome measures. The intervention is therefore referred to as FFC-AC-EIT. In addition to describing the protocol developed to test the effectiveness and feasibility of FFC-AC-EIT, a description of ways to overcome some of the barriers and challenges that can be encountered with this study is provided.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Marie Boltz
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Ashley Kuzmik
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Jeanette Ellis
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Chris Wells
- Department of Rehabilitation Services, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, Maryland, USA
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Vluggen S, Metzelthin S, Lima Passos V, Zwakhalen S, Huisman-de Waal G, de Man-van Ginkel J. Effect, economic and process-evaluation of a generic function focused care program for long-term care; study protocol of a multicenter cluster-randomized trial. BMC Nurs 2022; 21:121. [PMID: 35590409 PMCID: PMC9118723 DOI: 10.1186/s12912-022-00902-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nurses are in a key position to stimulate older people to maximize their functional activity and independence. However, nurses still often work in a task-oriented manner and tend to take over tasks unnecessarily. It is evident to support nurses to focus on the capabilities of older people and provide care assistance only when required. Function-Focused Care (FFC) is a holistic care-philosophy aiming to support nurses to deliver care in which functioning and independence of older people is optimized. Dutch and internationally developed FFC-based interventions often lack effectiveness in changing nurses' and client's behavior. Process-evaluations have yielded lessons and implications resulting in the development of an advanced generic FFC-program: the 'SELF-program'. The SELF-program aims to improve activity stimulation behavior of nurses in long-term care services, and with that optimize levels of self-reliance in activities of daily living (ADL) in geriatric clients. The innovative character of the SELF-program lies for example in the application of extended behavior change theory, its interactive nature, and tailoring its components to setting-specific elements and needs of its participants. This paper describes the outline, content and theoretical background of the SELF-program. Subsequently, this paper describes a protocol for the assessment of the program's effect, economic and process-evaluation in a two-arm (SELF-program vs care as usual) multicenter cluster-randomized trial (CRT). METHOD The proposed CRT has three objectives, including getting insight into the program's: (1) effectiveness regarding activity stimulation behavior of nurses and self-reliance in ADL of geriatric clients, and (2) cost-effectiveness from a societal perspective including assessments of quality of life and health-care use. Measurements will take place prior to program implementation (baseline), directly after (T1), and in long-term (T2). Parallel to the CRT, a process evaluation will be conducted to provide insight into the program's: (3) feasibility regarding implementation, mechanisms of impact and contextual factors. DISCUSSION The SELF-program was developed following the Medical Research Council framework, which addresses the systematic development, feasibility testing, evaluation and implementation of complex interventions. The program has been subjected to a feasibility study before and results of studies described in this protocol are expected to be available from end 2022 onwards. TRIAL-REGISTRATION The study is registered in the Dutch Trial Register ( NL9189 ), as of December 22 2020.
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Affiliation(s)
- Stan Vluggen
- Department of Health Services Research, Maastricht University, Care and Public Health Research Institute, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands.
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands.
| | - Silke Metzelthin
- Department of Health Services Research, Maastricht University, Care and Public Health Research Institute, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Valeria Lima Passos
- Department of Methodology and Statistics, Maastricht University, Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Sandra Zwakhalen
- Department of Health Services Research, Maastricht University, Care and Public Health Research Institute, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
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Effects on clients' daily functioning and common features of reablement interventions: a systematic literature review. Eur J Ageing 2022; 19:903-929. [PMID: 36692753 PMCID: PMC9729664 DOI: 10.1007/s10433-022-00693-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 01/26/2023] Open
Abstract
This systematic review aimed to provide an overview of reablement interventions according to the recently published ReAble definition and their effect on Activities of Daily Living (ADL). In addition, the most common and promising features of these reablement interventions were identified. Four electronic bibliographic databases were searched. Articles were included when published between 2002 and 2020, which described a Randomised or Clinical Controlled Trial of a reablement intervention matching the criteria of the ReAble definition, and had ADL functioning as an outcome. Snowball sampling and expert completion were used to detect additional publications. Two researchers screened and extracted the identified articles and assessed methodological quality; discrepancies were resolved by discussion and arbitration by a third researcher. Twenty relevant studies from eight countries were included. Ten of these studies were effective in improving ADL functioning. Identifying promising features was challenging as an equal amount of effective and non-effective interventions were included, content descriptions were often lacking, and study quality was moderate to low. However, there are indications that the use of more diverse interdisciplinary teams, a standardised assessment and goal-setting method and four or more intervention components (i.e. ADL-training, physical and/or functional exercise, education, management of functional disorders) can improve daily functioning. No conclusions could be drawn concerning the effectiveness on ADL functioning. The common elements identified can provide guidance when developing reablement programmes. Intervention protocols and process evaluations should be published more often using reporting guidelines. Collecting additional data from reablement experts could help to unpack the black box of reablement.
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Ashe MC, Azim FT, Ariza‐Vega P, Burns J, Clemson L, Grover S, Hoppmann CA, Langford D, Fleig L, Burton E. Determinants of implementing reablement into research or practice: A concept mapping study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 27:e1949. [DOI: 10.1002/pri.1949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/04/2022] [Accepted: 03/26/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Maureen C. Ashe
- Department of Family Practice The University of British Columbia Vancouver British Columbia Canada
- Centre for Hip Health and Mobility Vancouver British Columbia Canada
| | - Farah Tabassum Azim
- Department of Family Practice The University of British Columbia Vancouver British Columbia Canada
| | | | - Jane Burns
- Vancouver Coastal Health Authority Vancouver British Columbia Canada
- Department of Physical Therapy The University of British Columbia Vancouver British Columbia Canada
| | - Lindy Clemson
- Sydney School of Health Sciences The University of Sydney Sydney New South Wales Australia
| | - Sanya Grover
- Department of Family Practice The University of British Columbia Vancouver British Columbia Canada
| | - Christiane A. Hoppmann
- Centre for Hip Health and Mobility Vancouver British Columbia Canada
- Department of Psychology The University of British Columbia Vancouver British Columbia Canada
| | - Dolores Langford
- Vancouver Coastal Health Authority Vancouver British Columbia Canada
- Department of Physical Therapy The University of British Columbia Vancouver British Columbia Canada
| | - Lena Fleig
- Department of Psychology Medical School Berlin Berlin Germany
| | - Elissa Burton
- Curtin School of Allied Health Curtin University Perth Western Australia Australia
- enAble Institute Curtin University Perth Western Australia Australia
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Resnick B, Zimmerman S, Gaugler J, Ouslander J, Abrahamson K, Brandt N, Colón-Emeric C, Galik E, Gravenstein S, Mody L, Sloane PD, Unroe K, Verbeek H. Pragmatic Trials in Long-Term Care: Research Challenges and Potential Solutions in Relation to Key Areas of Care. J Am Med Dir Assoc 2022; 23:330-338. [PMID: 35219505 PMCID: PMC9446464 DOI: 10.1016/j.jamda.2021.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 01/12/2023]
Abstract
As a method of research, pragmatic trials are recommended so as to generate results that are applicable to real-world care. This intent is especially important for the millions of older adults who receive long-term care in thousands of nursing homes and assisted living communities across the country-and many millions more around the globe. This article presents key points raised by experts participating in a conference funded by the National Institute of Aging held at the 2021 conference of the Society for Post-Acute and Long-term Care Medicine. The purpose of the conference was to convene leading clinicians, researchers, and industry partners to address special considerations of pragmatic trials in long-term care. Cross-cutting and unique challenges and solutions to conducting pragmatic trials were discussed focusing on 3 areas of clinical relevance to long-term care: (1) functional care and outcomes, (2) psychosocial care and quality of life, and (3) medical care and outcomes, with a special focus on persons with dementia. Challenges and innovative solutions were organized across the 9 domains of the revised Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) Tool, and future research recommendations for pragmatic trials in long-term care were identified.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA.
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research and Schools of Social Work and Pubic Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph Gaugler
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Joseph Ouslander
- Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | | | - Nicole Brandt
- University of Maryland School of Pharmacy, Baltimore, MD, USA
| | | | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Stefan Gravenstein
- Brown University and Providence Veterans Administration Medical Center, Providence, RI, USA
| | - Lona Mody
- University of Michigan and Veterans Affair, Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Philip D. Sloane
- Cecil G. Sheps Center for Health Services Research and Schools of Social Work and Pubic Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathleen Unroe
- Indiana University School of Medicine and Regenstrief Institute, Inc, Center for Aging Research, Indianapolis, IN, USA
| | - Hilde Verbeek
- Maastricht University and Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
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12
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Resnick B, Zimmerman S, Gaugler J, Ouslander J, Abrahamson K, Brandt N, Colón-Emeric C, Galik E, Gravenstein S, Mody L, Sloane PD, Unroe K, Verbeek H. Pragmatic Trials in Long-Term Care: Research Challenges and Potential Solutions in Relation to Key Areas of Care. J Am Geriatr Soc 2022; 70:718-730. [PMID: 35195283 PMCID: PMC8904288 DOI: 10.1111/jgs.17699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 12/01/2022]
Abstract
As a method of research, pragmatic trials are recommended so as to generate results that are applicable to real-world care. This intent is especially important for the millions of older adults who receive long-term care in thousands of nursing homes and assisted living communities across the country-and many millions more around the globe. This article presents key points raised by experts participating in a conference funded by the National Institute of Aging held at the 2021 conference of the Society for Post-Acute and Long-term Care Medicine. The purpose of the conference was to convene leading clinicians, researchers, and industry partners to address special considerations of pragmatic trials in long-term care. Cross-cutting and unique challenges and solutions to conducting pragmatic trials were discussed focusing on 3 areas of clinical relevance to long-term care: (1) functional care and outcomes, (2) psychosocial care and quality of life, and (3) medical care and outcomes, with a special focus on persons with dementia. Challenges and innovative solutions were organized across the 9 domains of the revised Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) Tool, and future research recommendations for pragmatic trials in long-term care were identified.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA,Address correspondence to Barbara Resnick, PhD, CRNP, University of Maryland School of Nursing, 655 W Lombard St, Baltimore, MD 21201, USA. (B. Resnick)
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research and Schools of Social Work and Pubic Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph Gaugler
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Joseph Ouslander
- Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | | | - Nicole Brandt
- University of Maryland School of Pharmacy, Baltimore, MD, USA
| | | | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Stefan Gravenstein
- Brown University and Providence Veterans Administration Medical Center, Providence, RI, USA
| | - Lona Mody
- University of Michigan and Veterans Affair, Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Philip D. Sloane
- Cecil G. Sheps Center for Health Services Research and Schools of Social Work and Pubic Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathleen Unroe
- Indiana University School of Medicine and Regenstrief Institute, Inc, Center for Aging Research, Indianapolis, IN, USA
| | - Hilde Verbeek
- Maastricht University and Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
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13
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Resnick B, Zimmerman S, Gaugler J, Ouslander J, Abrahamson K, Brandt N, Colón-Emeric C, Galik E, Gravenstein S, Mody L, Sloane PD, Unroe K, Verbeek H. Pragmatic trials in long-term care: Research challenges and potential solutions in relation to key areas of care. Geriatr Nurs 2022; 44:293-301. [PMID: 35219534 PMCID: PMC9446463 DOI: 10.1016/j.gerinurse.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
As a method of research, pragmatic trials are recommended so as to generate results that are applicable to real-world care. This intent is especially important for the millions of older adults who receive long-term care in thousands of nursing homes and assisted living communities across the country-and many millions more around the globe. This article presents key points raised by experts participating in a conference funded by the National Institute of Aging held at the 2021 conference of the Society for Post-Acute and Long-term Care Medicine. The purpose of the conference was to convene leading clinicians, researchers, and industry partners to address special considerations of pragmatic trials in long-term care. Cross-cutting and unique challenges and solutions to conducting pragmatic trials were discussed focusing on 3 areas of clinical relevance to long-term care: (1) functional care and outcomes, (2) psychosocial care and quality of life, and (3) medical care and outcomes, with a special focus on persons with dementia. Challenges and innovative solutions were organized across the 9 domains of the revised Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) Tool, and future research recommendations for pragmatic trials in long-term care were identified.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA.
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research and Schools of Social Work and Pubic Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph Gaugler
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Joseph Ouslander
- Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | | | - Nicole Brandt
- University of Maryland School of Pharmacy, Baltimore, MD, USA
| | | | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Stefan Gravenstein
- Brown University and Providence Veterans Administration Medical Center, Providence, RI, USA
| | - Lona Mody
- University of Michigan and Veterans Affair, Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Philip D Sloane
- Cecil G. Sheps Center for Health Services Research and Schools of Social Work and Pubic Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathleen Unroe
- Indiana University School of Medicine and Regenstrief Institute, Inc, Center for Aging Research, Indianapolis, IN, USA
| | - Hilde Verbeek
- Maastricht University and Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
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Resnick B, Boltz M, Galik E, Fix S, Holmes S, Zhu S. Model Testing of the Factors That Influence Performance of Function Focused Care and Function Among Assisted Living Residents. J Appl Gerontol 2022; 41:401-410. [PMID: 35067104 PMCID: PMC8792441 DOI: 10.1177/0733464820976435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
The purpose of this study was to test a model of factors associated with participating in function focused care. Function focused care is a philosophy of care in which residents are encouraged to engage in functional and physical activities during care interactions. This was a secondary data analysis using data from the Dissemination and Implementation of Function Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT) study. Residents (n = 550) were recruited from 59 AL settings. The majority were female (n = 380, 69%) and White (n = 536, 97%). Model testing was done. Comorbidities, quality of interactions, environments, profit status, cognitive impairment, depression, and function were associated with function focused care and accounted for 17% of the variance. Next steps should include intervening on changeable factors (e.g., environments) and adding factors to better explain performance of function focused care such as motivation, resilience, and staff satisfaction.
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Affiliation(s)
| | - Marie Boltz
- Pennsylvania State University, University Park, USA
| | | | - Steven Fix
- University of Maryland School of Nursing, Baltimore, USA
| | | | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, USA
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Exploring Factors Associated With Successful Nonpharmacological Interventions for People With Dementia. Dement Neurocogn Disord 2022; 21:1-16. [PMID: 35154336 PMCID: PMC8811205 DOI: 10.12779/dnd.2022.21.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/27/2022] Open
Abstract
Background and purpose Methods Results Conclusions
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Resnick B, Boltz M, Galik E, Zhu S. The Impact of Cognitive impairment on Clinical Symptoms, Physical Activity and Care Interactions among Residents in Assisted Living Settings. Clin Nurs Res 2021; 31:310-319. [PMID: 34472369 DOI: 10.1177/10547738211040628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to describe differences in pain, behavioral symptoms, quality of staff-resident interactions, participation in function focused care and physical activity among residents with and without cognitive impairment in assisted living. This was a secondary data analysis using baseline data from an ongoing trial testing Function Focused Care for Assisted Living using the Evidence Integration Triangle (FFC-AL-EIT). A total of 550 residents were recruited from 59 communities. The average age of participants was 89.30 (SD = 7.63), the majority were white (98%), female (69%), had evidence of cognitive impairment (75%), and 5.16 (SD = 1.86) comorbidities. Those with cognitive impairment had more pain, were more sedentary and less likely to engage in function focused care activities. Addressing pain and implementing interventions for those with cognitive impairment to participate in function focused care may help optimize function and physical activity in assisted living residents.
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Affiliation(s)
| | - Marie Boltz
- Pennsylvania State University, University Park, USA
| | | | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, USA
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17
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The Impact of a Randomized Controlled Trial Testing the Implementation of Function-Focused Care in Assisted Living on Resident Falls, Hospitalizations, and Nursing Home Transfers. J Aging Phys Act 2021; 29:922-930. [PMID: 34140425 DOI: 10.1123/japa.2020-0426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/15/2020] [Accepted: 12/04/2020] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to test the impact of function-focused care on adverse outcomes in assisted living. This was a randomized trial including 85 settings. The age of the 794 recruited participants was 89.48 (SD = 7.43) years, the majority was female (n = 561, 71%) and White (n = 771, 97%). The percentage of residents in the treatment group experiencing a fall decreased at 12 months from 26% to 20% and the control group increased from 24% to 25%, p = .02. A greater percentage of residents in the treatment group transferred to nursing facilities at 4 months (4-1% in control vs. 4-5% in treatment, p = .02) and 12 months (4-2% in control and 4-7% in treatment, p = .01). There was no treatment effect on emergency room or hospital transfers. The findings support the safety of function-focused care related to falls and need for hospital transfers.
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18
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Physical Activity in Hospitalized Persons With Dementia: Feasibility and Validity of the MotionWatch 8. J Aging Phys Act 2021; 29:852-857. [PMID: 33863850 DOI: 10.1123/japa.2020-0275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/22/2020] [Accepted: 11/26/2020] [Indexed: 11/18/2022]
Abstract
Persons with dementia are at high risk for hospital-acquired disability, associated with low physical activity during hospitalizations. To determine the effectiveness of efforts to increase physical activity, a valid and reliable measurement approach is required. Data from an ongoing cluster randomized clinical trial examined the feasibility and validity of the MotionWatch 8 (MW8) triaxial actigraphy device. The sample included 321 participants of which 259 (81%) were willing to wear the MW8 for 24 hr. Regression analysis revealed that time in low activity, β = 0.17, t(255) = 2.9, p = .004, and time in moderate activity, β = 0.14, t(255) = 2.4, p = .017, measured by the MW8, were associated with participants' physical function. Engagement in moderate physical activity was associated with return to baseline function at discharge (Wald χ2 = 4.10, df = 1, p = .043). The study provides preliminary support for the feasibility and validity of the MW8 in hospitalized persons with dementia.
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Resnick B, Boltz M, Galik E, Fix S, Holmes S, Zhu S, Barr E. Testing the Impact of FFC-AL-EIT on Psychosocial and Behavioral Outcomes in Assisted Living. J Am Geriatr Soc 2021; 69:459-466. [PMID: 33095469 PMCID: PMC8116977 DOI: 10.1111/jgs.16886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study tested the impact of Function Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT) on: (1) care interactions between residents and direct care staff; and (2) behavior and psychological symptoms associated with dementia among residents. DESIGN This was a randomized controlled trial. SETTING A total of 59 assisted living facilities in Maryland, Pennsylvania, and Massachusetts participated. PARTICIPANTS The sample included 550 mostly White (98%), female (69%) residents with a mean age of 89.30 (standard deviation = 7.63) years. INTERVENTION The four-step FFC-AL-EIT intervention was implemented by a function focused care nurse facilitator working with a facility champion over 12 months. The steps included: (1) environment and policy assessments; (2) education; (3) establishing resident function focused care service plans; and (4) mentoring and motivating. MEASURES Resident descriptive data (e.g., age, sex, education, and comorbidities), depression, agitation, resistiveness to care, and the quality of care interactions were obtained at baseline and 4 and 12 months. Treatment fidelity data included environment and policy assessments, performance of function focused care by staff, and service plan assessments. RESULTS There was a significant positive treatment effect related to depression, agitation, resistiveness to care, and quality of care interactions with either less decline or some improvement in these behaviors and symptoms in the treatment versus control group. CONCLUSION The study provides some statistical support, which may not necessarily be clinically significant evidence, for psychosocial outcomes of residents and care interactions between staff and residents in assisted living settings.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, 655 West Lombard St, Baltimore MD 21218
| | - Marie Boltz
- Pennsylvania State University College of Nursing, 306 Nursing Sciences Building, University Park, PA 16802
| | - Elizabeth Galik
- University of Maryland School of Nursing, 655 West Lombard St, Baltimore MD 21218
| | - Steven Fix
- University of Maryland School of Nursing, 655 West Lombard St, Baltimore MD 21218
| | - Sarah Holmes
- University of Maryland School of Nursing, 655 West Lombard St, Baltimore MD 21218
| | - Shijun Zhu
- University of Maryland School of Nursing, 655 West Lombard St, Baltimore MD 21218
| | - Erik Barr
- University of Maryland School of Nursing, 655 West Lombard St, Baltimore MD 21218
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Feasibility, Reliability, and Validity of the MotionWatch 8 to Evaluate Physical Activity Among Older Adults With and Without Cognitive Impairment in Assisted Living Settings. J Aging Phys Act 2020; 29:391-399. [PMID: 33361499 DOI: 10.1123/japa.2020-0198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/28/2020] [Accepted: 08/01/2020] [Indexed: 12/23/2022]
Abstract
This study tested the feasibility, reliability, and validity of the MotionWatch 8 among assisted living residents with and without cognitive impairment. Data from the Dissemination and Implementation of Function Focused Care in Assisted Living Using the Evidence Integration Triangle study were used. The sample included 781 individuals from 85 facilities with a mean age of 89.48 (SD = 7.43) years. The majority were female (71%), White (97%), and overall (44%) had cognitive impairment. A total of 70% were willing to wear the MotionWatch 8. Reliability was supported as there was no difference in time spent in activity across three consecutive wear days. Validity was based on hypothesis testing, and function was associated with counts of activity at baseline (p = .001) and 4 months (p = .001). Those with cognitive impairment engaged in less physical activity (p = .04). The MotionWatch 8 is a useful option for measuring physical activity in older adults with and without cognitive impairment.
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21
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Verstraten CCJMM, Metzelthin SF, Schoonhoven L, Schuurmans MJ, de Man-van Ginkel JM. Optimizing patients' functional status during daily nursing care interventions: A systematic review. Res Nurs Health 2020; 43:478-488. [PMID: 32829518 PMCID: PMC7540410 DOI: 10.1002/nur.22063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/23/2020] [Indexed: 12/21/2022]
Abstract
Patients often experience a functional decline due to physical inactivity during illness. Nurses can influence the physical activity of patients while assisting them with activities of daily living. The purpose of this study was to identify effective interventions that are embedded in daily nursing care (irrespective of care setting) that aim to optimize the functional status of patients by increasing their physical activity. A systematic review was performed and reported following the preferred reporting items for systematic reviews and meta‐analyses. PubMed, CINAHL, and Cochrane were searched for studies from January 2002 to March 2019. The critical appraisal tools from the Joanna Briggs Institute were used to assess the risk of bias in individual studies. Study characteristics, intervention key components, and reported effects of included studies were extracted, summarized narratively, and compared. Twenty studies, evaluating nine different interventions were included. In these interventions, eight key components were identified. Four components were included in all six interventions with a positive effect on mobility, physical activity, or functional status. These components were: assessment of patient's functionality; goal setting with the patient; establishment of an individualized plan; and engagement of patients in physical and daily activity. The effects were limited due to the risk of bias in the studies, small sample sizes, limited clinical meaning of the effects, and variability of the adherence to the interventions. Multicomponent interventions were the most promising to enhance the functional status of patients. Future research should evaluate these interventions using research methods aiming at producing more rigorous evidence.
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Affiliation(s)
- Carolien C J M M Verstraten
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Silke F Metzelthin
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Lisette Schoonhoven
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Marieke J Schuurmans
- Education Center, UMC Utrecht Academy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Janneke M de Man-van Ginkel
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Barrett E, Casey B, Dollard M, McCarthy B, Casey D. Effectiveness of Functionally based Physical Activity Programs on Physical, Psychological, Cognitive, and Adverse Outcomes in Older Adults Living in Nursing Homes: Systematic Review. ACTIVITIES, ADAPTATION & AGING 2020. [DOI: 10.1080/01924788.2020.1794352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Eva Barrett
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Blathin Casey
- Physical Activity for Health (Pafh) Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Marie Dollard
- Physiotherapy Department, University Hospital Waterford, Waterford, Ireland
| | - Bernard McCarthy
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Dympna Casey
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
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Jung D, De Gagne JC, Lee M, Lee H. The effect of function-focused care on long-term care workers in South Korea. Geriatr Nurs 2020; 41:629-634. [PMID: 32376034 DOI: 10.1016/j.gerinurse.2020.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 03/14/2020] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to identify the effects of the Korean Function-Focused Care Program (K-FFCP) for residents of long-term care facilities (LTCRs) on long-term care workers' (LTCWs) knowledge, self-efficacy, and outcome expectations about function-focused care, as well as on their job satisfaction. The study adopted a quasi-experimental repeated-measures design. Participants included 50 LTCWs from two long-term care facilities (24 in the experimental group and 26 in the control group). Multivariate analysis of covariance showed that the effects of K-FFCP were significant on knowledge, efficacy, outcome expectation, and job satisfaction. Outcomes that could not be measured using scales were assessed through a focus group interview. The results suggest that LTCWs would benefit from a long-term educational program on function-focused care.
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Affiliation(s)
- Dukyoo Jung
- College of Nursing, Ewha Womans University, 309 Hellen hall, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 120-750, Republic of Korea.
| | | | - Minkyung Lee
- Hunter-Bellevue School of Nursing, Hunter College, CUNY, United States
| | - Hyesoon Lee
- College of Nursing, Ewha Womans University, 309 Hellen hall, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 120-750, Republic of Korea.
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Abstract
The purpose of this study was to describe physical activity and function of older adults in assisted living communities and test the association between moderate and vigorous activity and falls. This study used baseline data from 393 participants from the first two cohorts in the Function-Focused Care in Assisted Living Using the Evidence Integration Triangle study. The majority of participants were female (N = 276, 70%) and White (N = 383, 97%) with a mean age of 87 years (SD = 7). Controlling for age, cognition, gender, setting, and function, the time spent in moderate or vigorous levels of physical activity was associated with having a fall in the prior 4 months. Those who engaged in more moderate physical activity were 0.6% less likely to have a fall (OR = 0.994, Wald statistic = 5.54, p = .02), and those who engaged in more vigorous activity were 2% less likely to have a fall (OR = 0.980, Wald statistic = 3.88, p = .05).
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Blake D, Berry K, Brown LJE. A systematic review of the impact of person-centred care interventions on the behaviour of staff working in dementia care. J Adv Nurs 2019; 76:426-444. [PMID: 31657034 DOI: 10.1111/jan.14251] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 08/20/2019] [Accepted: 10/22/2019] [Indexed: 11/29/2022]
Abstract
AIM To examine the content, focus, and effectiveness of person-centred care (PCC) interventions aimed at increasing staff PCC behaviour in health and social care settings for people with dementia. DESIGN Systematic search and narrative synthesis of quantitative data. DATA SOURCES PsychINFO, Medline, EMBASE, Web of knowledge, CINAHL, ASSIA, and BNI were searched from inception to 5 November 2016. REVIEW METHODS All records retrieved were screened using predetermined eligibility criteria. Quality assessment was performed with the Effective Public Health Practice Project tool (EPHPP). RESULTS A total of 4,367 records were screened and 33 studies examining the impact of PCC interventions were included. Eight different categories of PCC intervention were identified, with seven of these having at least some evidence to support their effectiveness in increasing staff PCC behaviour. CONCLUSION The range of interventions and outcome measures identified in this review highlight different ways PCC behaviour can be demonstrated by staff and the range of interventions that can be used to enhance PCC staff behaviour. In future, more rigorously controlled research comparing the relative effectiveness of these interventions will support nursing facilities and staff to choose appropriate interventions to support them in enhancing PCC. IMPACT This study addressed the health priority of increasing PCC for people with dementia. It found preliminary evidence that seven of the eight intervention types identified are effective at increasing staff PCC behaviour in health and social care settings for people with dementia.
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Affiliation(s)
- Daniel Blake
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Laura J E Brown
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
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Jung D, Lee H, Lee M. Function-focused care programme for older people in Korean long-term care facilities. Int J Older People Nurs 2019; 15:e12277. [PMID: 31589382 DOI: 10.1111/opn.12277] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 07/31/2019] [Accepted: 08/29/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to develop and test the effect of the Korean Function-Focused Care Programme (K-FFCP) on cognition and physical and psychological status in long-term care facilities' (LTCs) residents. DESIGN A quasi-experimental repeated-measures design was used. METHODS The K-FFCP was developed to maintain and maximise functions of older people in LTCs. After implementing the K-FFCP for six weeks, differences in the cognitive status, activities of daily living (ADL) performance, physical capability, grip strength, fear of falling, depression and anxiety status of the two groups were examined using repeated-measures analysis of variance. Patient outcomes were evaluated at baseline and at 6 and 12 weeks after the intervention. RESULTS In the experimental group, a significant group-time interaction effect was reported for ADL performance and depression. CONCLUSION The current findings provided evidence of its feasibility and indicated significant improvement in older people's functions using the K-FFCP. Although this study is a pilot test, these results may confirm the importance of the K-FFCP for the maintenance of ADL performance in older people in LTCs.
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Affiliation(s)
- Dukyoo Jung
- College of Nursing, Ewha Womans University, Seoul, Korea
| | - Hyesoon Lee
- College of Nursing, Ewha Womans University, Seoul, Korea
| | - Minkyung Lee
- Hunter-Bellevue School of Nursing, Hunter College, CUNY, New York, NY, USA
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27
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Phillips LJ, Leary E, Blankenship J, Zimmerman S. Physical Function, Relocation, and Mortality Outcomes in Residential Care and Assisted Living Residents. J Aging Health 2019; 31:903-924. [PMID: 29254437 PMCID: PMC10081568 DOI: 10.1177/0898264317740047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study aimed to identify predictors of 6-month physical function and 12-month relocation or death in 272 residents of 34 residential care/assisted communities. Method: Measures collected at baseline, 6, and 12 months included health and demographic characteristics; self-reported pain, fatigue, and depressive symptoms; exercise self-efficacy, barriers, and expectations; attitudes on aging; performance-based physical function and physical activity; and community demographics, programs, and policies. GLIMMIX procedures for regression analyses with community as a random effect were run. Results: Better baseline physical function and grip strength, female sex, and residential care community predicted better 6-month physical function. At 12 months, 25.6% had relocated or died. The odds of 12-month relocation or death for 1-point increase in physical function score was 0.84 and for 1-point increase in depression score was 1.16. Discussion: Targets to promote longer tenure in residential care/assisted living include programs to ameliorate functional decline and depression screening and treatment.
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Resnick B, Galik E, Boltz M, Zhu S, Fix S, Vigne E. Impact of Function Focused Care and Physical Activity on Falls in Assisted Living Residents. Can J Nurs Res 2019; 52:45-53. [PMID: 31225738 DOI: 10.1177/0844562119856224] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BackgroundThere continues to be a belief among nurses, patients, and families that physical activity increases the risk of falling.PurposeThe purpose of this study was to test the hypothesis that controlling for age, function, cognition, medication use, gender, comorbidities, and cognition, residents who are exposed to Function Focused Care for Assisted Living (FFC-AL-EIT) and engage in moderate levels of physical activity would not be more likely to fall.MethodsThis was a secondary data analysis using data from the first two cohorts of a randomized trial testing FFC-AL-EIT in the United States.ResultsThe study included 381 residents, the majority of whom were female (70%), white (97%), with a mean age of 87.72 (standard deviation = 7.47). Those who engaged in more moderate-intensity physical activity were 1% less likely to fall (odds ratio = .99, p = .03). There was no significant association between exposure to function focused care and falling (odds ratio = 1.58, p = .09).ConclusionThere was no indication that those who were exposed to function focused care or those who engaged in moderate-level physical activity were more likely to fall. In fact, engaging in moderate-level physical activity was noted to be slightly protective of falling.
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Affiliation(s)
- Barbara Resnick
- Department of Gerontology, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Elizabeth Galik
- Department of Gerontology, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Marie Boltz
- Pennsylvania State University, College Station, PA, USA
| | - Shijun Zhu
- Department of Gerontology, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Steven Fix
- Department of Gerontology, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Erin Vigne
- Department of Gerontology, University of Maryland School of Nursing, Baltimore, MD, USA
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Evaluation of Person-Centredness in Rehabilitation for People Living with Dementia Is Needed: A Review of the Literature. J Aging Res 2019; 2019:8510792. [PMID: 31192013 PMCID: PMC6525915 DOI: 10.1155/2019/8510792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/14/2019] [Accepted: 03/24/2019] [Indexed: 11/21/2022] Open
Abstract
Background With an expected increase in the prevalence of dementia, change in care policies and healthcare systems worldwide is needed. Rehabilitation is increasingly recognised as contributing to dementia care. Rehabilitation subscribes to person-centredness, and thus, evaluations of person-centredness in rehabilitation for people living with dementia are relevant in order for healthcare professionals to know how best to practice person-centredness. Aim The aim of this study was to identify methods of evaluating person-centeredness in rehabilitation for people living with dementia. Materials and Methods Review of the literature using the search terms dementia, person-centredness, and rehabilitation or occupational therapy. Databases searched included: CINAHL, PubMed, Embase, PsycINFO, OTseeker, and SveMed+. The study included peer-reviewed articles from year 2000 to 2018 in Danish, English, Norwegian, or Swedish. Results Only one academic article met the inclusion criteria. In that article, person-centred practice was evaluated using observation and interview as well as analytical frameworks from person-centred care and occupational therapy. Conclusion Evaluations of person-centred practice in rehabilitation for people living with dementia in peer-reviewed literature are lacking. Evaluations are needed to identify effective strategies to pursue and uphold person-centred care. Given the dearth of research on evaluations of person-centredness in rehabilitation, this article included research in person-centred dementia care in the discussion, which potentially can inspire practice and research of rehabilitation for people living with dementia. To understand the complex nature of person-centredness, a variety of research methodologies of qualitative and quantitative characters are recommended for evaluations.
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Cameron ID, Dyer SM, Panagoda CE, Murray GR, Hill KD, Cumming RG, Kerse N. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 2018; 9:CD005465. [PMID: 30191554 PMCID: PMC6148705 DOI: 10.1002/14651858.cd005465.pub4] [Citation(s) in RCA: 169] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published in 2010 and updated in 2012. OBJECTIVES To assess the effects of interventions designed to reduce the incidence of falls in older people in care facilities and hospitals. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (August 2017); Cochrane Central Register of Controlled Trials (2017, Issue 8); and MEDLINE, Embase, CINAHL and trial registers to August 2017. SELECTION CRITERIA Randomised controlled trials of interventions for preventing falls in older people in residential or nursing care facilities, or hospitals. DATA COLLECTION AND ANALYSIS One review author screened abstracts; two review authors screened full-text articles for inclusion. Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction. We calculated rate ratios (RaR) with 95% confidence intervals (CIs) for rate of falls and risk ratios (RRs) and 95% CIs for outcomes such as risk of falling (number of people falling). We pooled results where appropriate. We used GRADE to assess the quality of evidence. MAIN RESULTS Thirty-five new trials (77,869 participants) were included in this update. Overall, we included 95 trials (138,164 participants), 71 (40,374 participants; mean age 84 years; 75% women) in care facilities and 24 (97,790 participants; mean age 78 years; 52% women) in hospitals. The majority of trials were at high risk of bias in one or more domains, mostly relating to lack of blinding. With few exceptions, the quality of evidence for individual interventions in either setting was generally rated as low or very low. Risk of fracture and adverse events were generally poorly reported and, where reported, the evidence was very low-quality, which means that we are uncertain of the estimates. Only the falls outcomes for the main comparisons are reported here.Care facilitiesSeventeen trials compared exercise with control (typically usual care alone). We are uncertain of the effect of exercise on rate of falls (RaR 0.93, 95% CI 0.72 to 1.20; 2002 participants, 10 studies; I² = 76%; very low-quality evidence). Exercise may make little or no difference to the risk of falling (RR 1.02, 95% CI 0.88 to 1.18; 2090 participants, 10 studies; I² = 23%; low-quality evidence).There is low-quality evidence that general medication review (tested in 12 trials) may make little or no difference to the rate of falls (RaR 0.93, 95% CI 0.64 to 1.35; 2409 participants, 6 studies; I² = 93%) or the risk of falling (RR 0.93, 95% CI 0.80 to 1.09; 5139 participants, 6 studies; I² = 48%).There is moderate-quality evidence that vitamin D supplementation (4512 participants, 4 studies) probably reduces the rate of falls (RaR 0.72, 95% CI 0.55 to 0.95; I² = 62%), but probably makes little or no difference to the risk of falling (RR 0.92, 95% CI 0.76 to 1.12; I² = 42%). The population included in these studies had low vitamin D levels.Multifactorial interventions were tested in 13 trials. We are uncertain of the effect of multifactorial interventions on the rate of falls (RaR 0.88, 95% CI 0.66 to 1.18; 3439 participants, 10 studies; I² = 84%; very low-quality evidence). They may make little or no difference to the risk of falling (RR 0.92, 95% CI 0.81 to 1.05; 3153 participants, 9 studies; I² = 42%; low-quality evidence).HospitalsThree trials tested the effect of additional physiotherapy (supervised exercises) in rehabilitation wards (subacute setting). The very low-quality evidence means we are uncertain of the effect of additional physiotherapy on the rate of falls (RaR 0.59, 95% CI 0.26 to 1.34; 215 participants, 2 studies; I² = 0%), or whether it reduces the risk of falling (RR 0.36, 95% CI 0.14 to 0.93; 83 participants, 2 studies; I² = 0%).We are uncertain of the effects of bed and chair sensor alarms in hospitals, tested in two trials (28,649 participants) on rate of falls (RaR 0.60, 95% CI 0.27 to 1.34; I² = 0%; very low-quality evidence) or risk of falling (RR 0.93, 95% CI 0.38 to 2.24; I² = 0%; very low-quality evidence).Multifactorial interventions in hospitals may reduce rate of falls in hospitals (RaR 0.80, 95% CI 0.64 to 1.01; 44,664 participants, 5 studies; I² = 52%). A subgroup analysis by setting suggests the reduction may be more likely in a subacute setting (RaR 0.67, 95% CI 0.54 to 0.83; 3747 participants, 2 studies; I² = 0%; low-quality evidence). We are uncertain of the effect of multifactorial interventions on the risk of falling (RR 0.82, 95% CI 0.62 to 1.09; 39,889 participants; 3 studies; I² = 0%; very low-quality evidence). AUTHORS' CONCLUSIONS In care facilities: we are uncertain of the effect of exercise on rate of falls and it may make little or no difference to the risk of falling. General medication review may make little or no difference to the rate of falls or risk of falling. Vitamin D supplementation probably reduces the rate of falls but not risk of falling. We are uncertain of the effect of multifactorial interventions on the rate of falls; they may make little or no difference to the risk of falling.In hospitals: we are uncertain of the effect of additional physiotherapy on the rate of falls or whether it reduces the risk of falling. We are uncertain of the effect of providing bed sensor alarms on the rate of falls or risk of falling. Multifactorial interventions may reduce rate of falls, although subgroup analysis suggests this may apply mostly to a subacute setting; we are uncertain of the effect of these interventions on risk of falling.
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Affiliation(s)
- Ian D Cameron
- The University of SydneyJohn Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical SchoolReserve RoadSt LeonardsNSWAustralia2065
| | - Suzanne M Dyer
- DHATR Consulting120 Robsart StreetParksideSouth AustraliaAustralia5063
| | - Claire E Panagoda
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health DistrictSt LeonardsNSWAustralia2065
| | - Geoffrey R Murray
- Illawarra Shoalhaven Local Health DistrictAged Care, Rehabilitation and Palliative CareWarrawongAustralia
| | - Keith D Hill
- Curtin UniversitySchool of Physiotherapy and Exercise Science, Faculty of Health SciencesGPO Box U1987PerthWestern AustraliaAustralia6845
| | - Robert G Cumming
- Sydney Medical School, University of SydneySchool of Public HealthRoom 306, Edward Ford Building (A27)Fisher RoadSydneyNSWAustralia2006
| | - Ngaire Kerse
- University of AucklandDepartment of General Practice and Primary Health CarePrivate Bag 92019AucklandNew Zealand
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Positive Interactive Engagement (PIE): A pilot qualitative case study evaluation of a person-centred dementia care programme based on Montessori principles. DEMENTIA 2018; 19:975-991. [DOI: 10.1177/1471301218792144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Altered behaviour associated with dementia can present a number of challenges in the provision of care within both community and residential aged care settings. This paper presents a qualitative case study investigation of the implementation of the Positive Interactive Engagement programme within a residential aged care setting. The Positive Interactive Engagement programme incorporates non-pharmacological sensory techniques that have been informed by a person-centred, Montessori approach. Face-to-face semi-structured interviews with workers at a residential aged care facility in South Australia yielded seven case studies. Data were thematically analysed both within and between cases. Our data indicate the programme demonstrates underlying Montessori principles and supports participant behaviour change, with a noted reduction in ‘disruptive’ behaviours and increased social connection amongst participants. Programme staff report increased job satisfaction. The Positive Interactive Engagement programme offers a model that demonstrates encouraging outcomes, and further research would be useful in ascertaining whether these outcomes translate to quantifiable improvements in the quality of life for people with dementia in a residential aged care setting.
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From clinical work to dissemination of interventions. J Am Assoc Nurse Pract 2018; 30:308-310. [DOI: 10.1097/jxx.0000000000000044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Henskens M, Nauta IM, Drost KT, Scherder EJ. The effects of movement stimulation on activities of daily living performance and quality of life in nursing home residents with dementia: a randomized controlled trial. Clin Interv Aging 2018; 13:805-817. [PMID: 29750023 PMCID: PMC5933359 DOI: 10.2147/cia.s160031] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background Nursing home (NH) residents with dementia experience a reduced quality of life (QoL), in part, due to a dependence in performing activities of daily living (ADL). Stimulating movement is associated with improvements in ADL performance. Therefore, movement stimulating interventions, such as ADL training and exercise, focus on optimizing ADL performance to improve QoL. This study aimed to evaluate the effect of three movement stimulating interventions on QoL and ADL performance in NH residents with dementia. Methods In this 6-month double parallel randomized controlled trial, the effects of ADL training, a multicomponent aerobic and strength exercise training, and a combined ADL and exercise training were analyzed in 87 NH residents with dementia. The Global Deterioration Scale was used to classify the severity of dementia. Participants were screened at baseline using the 6 minute walk test and Mini-Mental State Examination. The Qualidem, and the Care Dependency Scale and Erlangen ADL test were evaluated at baseline, and after 3 and 6 months to measure QoL and ADL, respectively. Multilevel analyses were adjusted for baseline performance, age, and gender. Results A 6-month ADL training positively affected overall QoL (p = 0.004) and multiple aspects of QoL, including care relationship (p = 0.004), positive self-image (p = 0.002), and feeling at home (p = 0.001), compared to care-as-usual. No benefits were observed of exercise on QoL. No benefits were observed of a combined ADL and exercise intervention on QoL. No effects were found of the three movement interventions on ADL performance. Conclusion The results indicate that ADL training can improve QoL. The results contribute to the limited knowledge regarding the effect of movement stimulation on resident outcomes. Further large-scale studies are recommended.
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Affiliation(s)
- Marinda Henskens
- Department of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ilse M Nauta
- Department of Neurology, MS Center Amsterdam, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | | | - Erik Ja Scherder
- Department of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Resnick B, Galik E, Boltz M, Vigne E, Holmes S, Fix S, Zhu S. Physical Activity and Function in Assisted Living Residents. West J Nurs Res 2018; 40:1734-1748. [PMID: 29560808 DOI: 10.1177/0193945918764448] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to consider the feasibility, reliability, and validity of MotionWatch 8. A total of 249 residents were recruited from 26 assisted living settings. Data collection included demographics, comorbidities, function (Barthel Index), physical activity (MotionWatch 8), and falls. The mean age of participants was 86.86 ( SD = 7.0), the majority were women 179 (74%) and White ( N = 232, 96%). A total of 86% of participants wore the MotionWatch 8. There were no significant differences in physical activity over 3 days of testing. The MotionWatch 8 findings were significantly associated with activities of daily living (ADL) function. There were no significant differences in ADL function or physical activity between those who did and did not fall. The study provides additional support for the feasibility, reliability, and validity of the MotionWatch 8 and confirms that older adults living in assisted living settings spend the majority of their time in sedentary activity.
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Affiliation(s)
| | | | - Marie Boltz
- 2 Pennsylvania State University, University Park, USA
| | - Erin Vigne
- 1 University of Maryland, Baltimore, MD, USA
| | | | - Steven Fix
- 1 University of Maryland, Baltimore, MD, USA
| | - Shijun Zhu
- 1 University of Maryland, Baltimore, MD, USA
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Resnick B, Kolanowski A, Van Haitsma K, Galik E, Boltz M, Ellis J, Behrens L, Flanagan NM, Eshraghi KJ, Zhu S. Testing the evidence integration triangle for implementation of interventions to manage behavioral and psychological symptoms associated with dementia: Protocol for a pragmatic trial. Res Nurs Health 2018; 41:228-242. [PMID: 29485197 DOI: 10.1002/nur.21866] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/27/2017] [Indexed: 01/30/2023]
Abstract
Behavioral and psychological symptoms of dementia (BPSD) include aggression, agitation, resistiveness to care, depression, anxiety, apathy, and hallucinations. BPSD are common in nursing home residents and can be ameliorated using person-centered approaches. Despite regulatory requirements, less than 2% of nursing homes consistently implement person-centered behavioral approaches. In a National Institute of Nursing Research-funded research protocol, we are implementing a pragmatic cluster randomized clinical trial designed to enable staff in nursing homes to reduce BPSD using behavioral approaches while optimizing function, preventing adverse events, and improving quality of life of residents. The implementation is based on use of the Evidence Integration Triangle (EIT), a parsimonious, community-engaged participatory framework that is well suited to the complexity and variability in the nursing home environment. A total of 50 nursing home communities will be randomized to EIT-4-BPSD or education only. Primary Aim 1 is to determine if communities exposed to EIT-4-BPSD demonstrate evidence of implementation evaluated by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) criteria. Primary Aim 2 is to evaluate the feasibility, utility, and cost of the EIT approach in EIT-4-BPSD communities.
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Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland, Baltimore, Maryland
| | - Ann Kolanowski
- Pennsylvania State University, University Park, Pennsylvania
| | | | - Elizabeth Galik
- School of Nursing, University of Maryland, Baltimore, Maryland
| | - Marie Boltz
- Pennsylvania State University, University Park, Pennsylvania
| | - Jeanette Ellis
- School of Nursing, University of Maryland, Baltimore, Maryland
| | - Liza Behrens
- Pennsylvania State University, University Park, Pennsylvania
| | - Nina M Flanagan
- Decker School of Nursing, Binghamton University, Binghamton, New York
| | | | - Shijun Zhu
- School of Nursing, University of Maryland, Baltimore, Maryland
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The Role of Physicians Practicing in Assisted Living: What Changes Do We Really Need? J Am Med Dir Assoc 2018; 19:104-105. [DOI: 10.1016/j.jamda.2017.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 12/04/2017] [Indexed: 11/21/2022]
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Henskens M, Nauta IM, Scherder EJA, Oosterveld FGJ, Vrijkotte S. Implementation and effects of Movement-oriented Restorative Care in a nursing home - a quasi-experimental study. BMC Geriatr 2017; 17:243. [PMID: 29058632 PMCID: PMC5651629 DOI: 10.1186/s12877-017-0642-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/11/2017] [Indexed: 11/24/2022] Open
Abstract
Background The prevalence of dementia is expected to increase rapidly, and institutionalization is a common consequence of the disease. Dependence in activities of daily living (ADL) is a predictor for institutionalization and a determinant for the quality of life (QoL). A promising method to increase functional independence in nursing homes is a restorative care or function focused care (FFC) approach. Movement-oriented restorative care (MRC) is derived from the concept of FFC and restorative care and focuses on the integration of physical activity in the daily lives of nursing home residents with dementia using a multidisciplinary approach. The objective of this study was to assess the effectiveness of MRC in preservation of ADL independence and QoL in nursing home residents with dementia. Methods In this quasi-experimental 12-month study, the effects of MRC were compared to care as usual in 61 nursing home residents with moderate to severe dementia. The outcome measures were ADL independence and QoL. These outcomes were measured five times (i.e. at baseline, and after 3, 6, 9, and 12 months). Additionally, data was collected regarding the degree of implementation, and the barriers to the implementation process. The effect of the intervention was analyzed using linear mixed model analyses. Results There was no significant overall intervention effect on ADL independence and QoL. A significant group-by-time interaction was found for the QoL subscale positive self-image: after a 12 month intervention period, the MRC group scored significantly better than the control group on positive self-image. Regarding the other subscales and the total score of the QoL, as well as ADL, no significant group-by-time interactions were found. Conclusions MRC did not demonstrate significant improvements in ADL or QoL. After a 12-month intervention period, residents who received MRC showed higher scores on positive self-image compared to the control group. This study contributes to the limited research regarding the effect of MRC on resident outcomes. Further large-scale studies are recommended. Trial registration The trial was retrospectively registered in http://clinicaltrials.gov on February 2, 2017: NCT03001232.
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Affiliation(s)
- Marinda Henskens
- Department of Clinical Neuropsychology, VU University Amsterdam, van der Boechorststraat 1, 1081 BT, Amsterdam, Netherlands.
| | - Ilse M Nauta
- Department of Neurology, VU University Medical Center, de Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Erik J A Scherder
- Department of Clinical Neuropsychology, VU University Amsterdam, van der Boechorststraat 1, 1081 BT, Amsterdam, Netherlands
| | - Frits G J Oosterveld
- Saxion University of Applied Science, P.O. Box 75.000, 7500 KB, Enschede, Netherlands
| | - Susan Vrijkotte
- Zorggroep Solis, Postbus 5014, 7400 GC, Deventer, Netherlands.,Human Physiology Research Group, VU University Brussel, Pleinlaan 2, B-1050, Brussels, Belgium
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Galik E, Resnick B, Vigne E, Holmes SD, Nalls V. Reliability and Validity of the Resistiveness to Care Scale Among Cognitively Impaired Older Adults. J Am Med Dir Assoc 2017; 18:59-64. [PMID: 27776986 PMCID: PMC5183554 DOI: 10.1016/j.jamda.2016.08.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 08/19/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Resistiveness to care is behavior that prevents or interferes with caregivers' performing or assisting with activities of daily living and puts residents at risk for inappropriate use of antipsychotic drugs, other restraining interventions, social isolation, and physical abuse. The purpose of this study was to establish the psychometric properties of a previously developed Resistiveness to Care measure. PROCEDURES This was a descriptive study using baseline data from an ongoing randomized controlled trial testing a Function and Behavior Focused Care (FBFC) intervention. Residents were eligible to participate if they were 55 years of age or older, had a Mini-Mental State Exam (MMSE) score of 15 or less, and were not enrolled in hospice or admitted for subacute care. Descriptive information included age, race, gender, cognitive status, and marital status. In addition to the Resistance to Care Scale, the Barthel Index, the Physical Activity Survey in Long Term Care (PAS-LTC), and the Cohen-Mansfield Agitation Inventory (CMAI) were completed. Psychometric testing was done using Rasch analysis and the Winsteps statistical program. MAIN FINDINGS The participants were moderate to severely cognitively impaired (MMSE of 7.23), functionally dependent (Barthel Index 47.31, SD 27.59), and engaged in only 134.17 (SD = 207.32) minutes of physical activity daily. Reliability was supported based on a Cronbach alpha of 0.84 and the DIF analysis, as there was no difference in function of the items between male and female participants. Validity was supported as all items fit the measurement model based on INFIT and OUTFIT statistics. CONCLUSIONS The findings support the reliability and validity of the Resistiveness to Care Scale for use with older adults with dementia in nursing home settings. Future work with the measure may benefit from the addition of items that are easier to endorse with regard to resistiveness to care (shutting eyes or spitting out food may be useful additions).
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Affiliation(s)
| | | | - Erin Vigne
- University of Maryland School of Nursing, Baltimore, MD
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Resnick B, Kolanowski A, Van Haitsma K, Boltz M, Galik E, Bonner A, Vigne E, Holtzman L, Mulhall PM. Pilot Testing of the EIT-4-BPSD Intervention. Am J Alzheimers Dis Other Demen 2016; 31:570-579. [PMID: 27609932 PMCID: PMC10852713 DOI: 10.1177/1533317516662337] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Behavioral and psychological symptoms of dementia are common in nursing home residents, and the Centers for Medicare and Medicaid Services now require that nonpharmacological interventions be used as a first-line treatment. Few staff know how to implement these interventions. The purpose of this study was to pilot test an implementation strategy, Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD), which was developed to help staff integrate behavioral interventions into routine care. The EIT-4-BPSD was implemented in 2 nursing homes, and 21 residents were recruited. A research nurse facilitator worked with facility champions and a stakeholder team to implement the 4 steps of EIT-4-BPSD. There was evidence of reach to all staff; effectiveness with improvement in residents' quality of life and a decrease in agitation; adoption based on the environment, policy, and care plan changes; and implementation and plans for maintenance beyond the 6-month intervention period.
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Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | | | | | - Marie Boltz
- William F. Connell School of Nursing, Boston College, Boston, MA, USA
| | - Elizabeth Galik
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Alice Bonner
- School of Nursing, Northeastern University, Boston, MA, USA
| | - Erin Vigne
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Lauren Holtzman
- School of Nursing, University of Maryland, Baltimore, MD, USA
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Resnick B, Galik E, Vigne E, Carew AP. Dissemination and Implementation of Function Focused Care for Assisted Living. HEALTH EDUCATION & BEHAVIOR 2016; 43:296-304. [PMID: 27178495 DOI: 10.1177/1090198115599984] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Assisted living (AL) settings are residential settings that provide housing and supportive services for older and disabled adults. Although individuals in AL are less functionally impaired than those in nursing home settings, they engage in limited amounts of physical activity and experience more rapid functional decline than their peers in nursing homes. Function Focused Care for Assisted Living (FFC-AL) was developed to prevent decline, improve function, and increase physical activity among residents living in these settings. The purpose of this study was to disseminate and implement the previously established, effective FFC-AL approach to 100 AL settings. Evidence of our ability to successfully disseminate and implement FFC-AL across these settings was established using the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance model. Settings were eligible to participate if they had more than eight beds and identified a nurse (i.e., registered nurse, licensed practical nurse, or direct care worker) champion to facilitate the implementation process. Setting recruitment was done via mailed invitations to 300 eligible ALs and e-mails to relevant AL organizations. Evidence of reach was based on our ability to recruit 99 ALs with adoption of the intervention in 78 (78%). There was a significant improvement in policies supporting function-focused care and in establishing environments that supported function-focused care, and there was evidence of enduring changes in settings indicative of maintenance. We were able to implement all aspects of the intervention although challenges were identified. Future work should focus on using more face-to-face interactions with champions along with identified stakeholders, evaluating characteristics of champions to establish those who are most successful, and recruiting residents to obtain resident-specific outcomes.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Erin Vigne
- University of Maryland School of Nursing, Baltimore, MD, USA
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Liu W, Galik E, Boltz M, Nahm ES, Lerner N, Resnick B. Factors associated with eating performance for long-term care residents with moderate-to-severe cognitive impairment. J Adv Nurs 2015; 72:348-60. [DOI: 10.1111/jan.12846] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 01/26/2023]
Affiliation(s)
- Wen Liu
- The University of Iowa College of Nursing; Iowa USA
| | - Elizabeth Galik
- University of Maryland School of Nursing; Baltimore Maryland USA
| | - Marie Boltz
- Boston College Connell School of Nursing; Chestnut Hill Massachusetts USA
| | - Eun-Shim Nahm
- University of Maryland School of Nursing; Baltimore Maryland USA
| | - Nancy Lerner
- University of Maryland School of Nursing; Baltimore Maryland USA
| | - Barbara Resnick
- University of Maryland School of Nursing; Baltimore Maryland USA
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Liu W, Galik E, Nahm ES, Boltz M, Resnick B. Optimizing Eating Performance for Long-Term Care Residents With Dementia: Testing the Impact of Function-Focused Care for Cognitively Impaired. J Am Med Dir Assoc 2015; 16:1062-8. [PMID: 26255100 DOI: 10.1016/j.jamda.2015.06.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/26/2015] [Accepted: 06/26/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The objective of this study was to evaluate the impact of a well-developed theory-based function-focused care for cognitively impaired (FFC-CI) intervention on eating performance among long-term care (LTC) residents with moderate-to-severe cognitive impairment. DESIGN A secondary analysis of longitudinal data from 2 cluster-randomized controlled trials that originally tested the impact of FFC-CI on all function and physical activities. PARTICIPANTS AND SETTING Participants were 199 residents with moderate-to-severe cognitive impairment from 4 nursing homes and 4 assisted living facilities. MEASUREMENTS Data at baseline, and 3 and 6 months were used. Resident outcome data used in this analysis included eating performance conceptualized using the single self-care "feeding" item in the Barthel Index, cognitive function by Mini-Mental State Examination, sitting balance conceptualized using the single "chair sit-sitting balance" item in the Tinetti Gait and Balance scale, physical capability by Physical Capability Scale, depression by Cornell Scale for Depression in Dementia, and agitation by Cohen-Mansfield Agitation Inventory (short form). RESULTS At baseline, almost one-third (32.2%) of the 199 residents needed help with eating. There was no significant change with regard to eating performance over time in both groups, and no significant treatment by time difference between groups in eating performance (P = .195). CONCLUSION Current findings support a need to revise the FFC-CI to better address eating performance. Future work may benefit from a stronger focus on eating performance rather than the more commonly addressed functional tasks, such as bathing, dressing, and ambulation. In addition, the inclusion of a more heterogeneous group of LTC residents with regard to eating performance is needed to test the impact of the revised approach on eating performance.
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Affiliation(s)
- Wen Liu
- Department of Organizational System and Adult Health, University of Maryland School of Nursing, Baltimore, MD.
| | - Elizabeth Galik
- Department of Organizational System and Adult Health, University of Maryland School of Nursing, Baltimore, MD
| | - Eun-Shim Nahm
- Department of Organizational System and Adult Health, University of Maryland School of Nursing, Baltimore, MD
| | - Marie Boltz
- Boston College Connell School of Nursing, Chestnut Hill, MA
| | - Barbara Resnick
- Department of Organizational System and Adult Health, University of Maryland School of Nursing, Baltimore, MD
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