Consistent with a care approach that optimizes the underlying ability of the patient/resident, the Omnibus Budget Reconciliation Act of 1987 mandated that residents attain and maintain their highest ...level of function. Restorative Care, which more recently has been referred to as Function Focused Care 4, is a philosophy of care that focuses on evaluating the older adult's underlying capability with regard to function and physical activity and helping him or her optimize and maintain functional abilities and increase time spent in physical activity. The purpose of this review was to consider the work that has been done in testing function focused care and to provide guidance on the best ways in which to integrate this philosophy within any setting.
A systematic review of the available literature studying the impact of function focused care approaches was performed using MEDLINE and CINAHL search engines. The studies included were evaluated based on such things as design, specifically whether or not they were experimental designs (which included randomized trials or quasi experimental studies) or single group studies intended to pilot an intervention or for purposes of feasibility; randomization approaches; sample size/number of residents or patients included; descriptions of the intervention such as if there was a champion utilized (research supported or staff); or if motivation of older adults or caregivers was addressed.
Out of 41 articles identified by CINAHL and 148 via MEDLINE, 20 articles met our inclusion and exclusion criteria. Overall the results provided support for the safety and efficacy of function focused care approaches. Continued research is particularly needed to consider best approaches for dissemination and implementation of function focused care and to test function focused care in acute care settings.
Objectives
To develop and test the Function‐Focused Care in Assisted Living (FFC‐AL) intervention so as to alter the decline that older adults in AL experience.
Design
Cluster‐randomized controlled ...trial using repeated measures to test the effect of FFC‐AL.
Setting
Four AL facilities with at least 100 beds.
Participants
One hundred seventy‐one residents and 96 direct care workers (DCWs) were recruited. Ninety‐five of the DCWs were female (99%), and 59 were black (62%), with a mean age of 41.7 ± 13.8. The residents were mostly female (80%), white (93%), and widowed (80%), with a mean age of 87.7 ± 5.7.
Intervention
FFC‐AL included four components implemented by a research‐supported function focused‐care nurse (FFCN) and a site‐identified champion over a 12‐month period. Control sites were exposed to FFC education only.
Measurements
Outcomes for residents included psychosocial domains (mood, resilience, self‐efficacy, and outcome expectations for function and physical activity), function, gait and balance, and actigraphy. Outcomes for DCWs included knowledge, performance, and beliefs associated with FFC.
Results
DCWs in treatment sites provided more FFC by 12 months than those in control sites. Residents in treatment sites demonstrated less decline in function, a greater percentage returned to ambulatory status, and there were positive trends demonstrating more time in moderate‐level physical activity at 4 months and more overall counts of activity at 12 months than for residents in control sites.
Conclusion
Using a function‐focused approach in AL may help prevent some of the functional decline commonly noted in these settings.
Behavioral and psychological symptoms of distress in dementia (BPSD) are major drivers of poor quality of life, caregiver burden, institutionalization, and cost of care in nursing homes. The Evidence ...Integration Triangle (EIT)-4-BPSD in nursing homes was a pragmatic Hybrid III trial of an implementation strategy to help staff use evidence-based non-pharmacological interventions to prevent and manage BPSD. This study aimed to describe and explore the stakeholders' perceptions of the process to implement the EIT-4-BPSD strategy including its utility, and the barriers and facilitators to implementation in real-world settings.
EIT-4-BPSD was a multi-layer implementation strategy that engaged nursing home stakeholder groups to define community specific goals towards reducing BPSD over a 12-month period. Stakeholder groups from nursing homes that completed all 12-months of the implementation strategy were invited to participate in this process evaluation study. Qualitative data from focus group transcripts were analyzed using a conventional content analysis. Emerging codes were sorted into categories, then organized in meaningful clusters based on the domains of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework.
The EIT-4-BPSD implementation strategy was completed in 21 nursing homes; 93 stakeholders participated in focus groups. Over half of participating nursing homes reported meeting their BPSD goals as expected or more. Challenges, facilitators, and contextual factors reported by stakeholder members explains variability in the implementation of EIT-4-BPSD strategy in 11 key categories: family; staff; organizational; staff, environmental, and resident outcomes; utility of EIT resources; adoption barriers and facilitators; care process adaptations; and future planning.
Stakeholders offered guidance on salient factors influencing the feasibility and utility of EIT-4-BPSD adoption and implementation to consider in future implementation research that aims to improve behavioral well-being in NH residents living with dementia. Engagement of family and staff at all levels of the organization (Management, leadership, and direct care); and measurement of staff, environmental, and resident outcomes were perceived as critical for future implementation success. While regulations, finances, and competing demands on staff time were perceived as reducing implementation success.
The Testing the Implementation of EIT-4-BPSD study was registered in the ClinicalTrials.gov ( NCT03014570 ) January 9, 2017.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Currently, most rehabilitation services for individuals who sustain a hip fracture are not designed to meet the complex needs of those who also have cognitive impairment. The goal of this review was ...to identify current best practices for rehabilitation in long-term care settings and approaches to optimize outcomes among individuals with dementia and other cognitive impairments post-hip fracture.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement was used to guide the review. Five electronic databases, including PubMed, EMBASE, CINAHL (EBSCO), Medline (EBSCO), and PsycINFO (EBSCO), were searched for intervention studies published in English language journals. Studies were eligible if they focused on rehabilitation interventions post-hip fracture among older individuals (≥ 65 years) with cognitive impairment who were living in or transferred to long-term care or postacute/rehabilitation settings post-hip fracture. Studies were excluded if they did not enroll individuals with cognitive impairment, the study was descriptive without any intervention content, or the intervention components were only medication, surgical approach or medical treatment.
A total of 4478 records were identified, 1915 of which were duplicative, 2563 were relevant based on title, and after careful review 7 studies were included. Two included studies were randomized controlled trials, one was a single group pre- and post-test, one a descriptive comparison between those with and without cognitive impairment, one a case controlled matched trial, one a nonequivalent groups trial, and one a case report. The interventions varied between manipulating the type and amount of exercise or testing multifactorial issues including environmental interventions and the use of an interdisciplinary team to address psychosocial factors, medication management, use of assistive devices, and specific preferences or concerns of the individuals.
The evidence summarized in this review suggests that it is feasible to implement rehabilitation programs focused on individuals with cognitive impairment in postacute care settings. Moreover, there was evidence to suggest that intensive rehabilitation and exercise activities are beneficial, although innovative approaches may be needed to engage individuals with cognitive impairment.
Background
Internationally, as the number of older adults increases, different types of care settings are evolving to address the care needs of this growing group of individuals.
Aims and objectives
...The purpose of this study was to describe and compare clinical outcomes of residents with moderate to severe cognitive impairment living in residential care facilities (RCFs) and nursing homes (NHs).
Design
This was a secondary data analysis that included data from two studies testing a Function‐Focused Care for Cognitively Impaired (FFC‐CI) Intervention.
Methods
A total of 96 participants were from RCFs and 103 were from NHs. Change scores over a 6‐month period in RCF and NH residents were evaluated using a multivariate analysis of variance.
Results
Residential care facilities residents had more agitation, better function and engaged in approximately twice as much physical activity as those in NH settings at baseline. Controlling for treatment status and baseline differences, over 6 months, RCF residents showed a decrease of −22.77 ± 41.47 kilocalories used in 24 hours while those in NHs increased to a mean of 10.49 ± 33.65 kilocalories used. With regard to function, residents in RCFs declined 10.97 ± 18.35 points on the Barthel Index, while those in NHs increased 10.18 ± 19.56 points.
Conclusions
In this sample, NH residents were more likely to be African American, had more comorbidities, less cognitive impairment, engaged in less physical activity, were more impaired functionally and had less agitation than those in RCFs. Controlling for treatment group status and baseline differences in comorbidities, cognitive status and race, residents in RCFs declined more in terms of functional and physical activity over a 6‐month period.
Implications for practice
Ongoing research and clinical work is needed to understand the impact of care settings on clinical outcomes.
Chronic pain imposes a significant burden to the healthcare system and adversely affects patients' quality of life. Traditional subjective assessments, however, do not adequately capture the complex ...phenomenon of pain, which is influenced by a multitude of factors including environmental, developmental, genetic, and psychological. Quantitative sensory testing (QST), established as a protocol to examine thermal and mechanical sensory function, offers insight on potential mechanisms contributing to an individual's experience of pain, by assessing their perceived response to standardized delivery of stimuli. Although the use of QST as a research methodology has been described in the literature in reference to specific pain populations, this manuscript details application of QST across a variety of chronic pain conditions. Specific conditions include lower extremity chronic pain, knee osteoarthritis, chronic low back pain, temporomandibular joint disorder, and irritable bowel syndrome. Furthermore, we describe the use of QST in placebo/nocebo research, and discuss the use of QST in vulnerable populations such as those with dementia. We illustrate how the evaluation of peripheral sensory nerve function holds clinical promise in targeting interventions, and how using QST can enhance patient education regarding prognostic outcomes with particular treatments. Incorporation of QST methodology in research investigations may facilitate the identification of common mechanisms underlying chronic pain conditions, guide the development of non-pharmacological behavioral interventions to reduce pain and pain-related morbidity, and enhance our efforts toward reducing the burden of chronic pain.
Abstract
The purpose of this study was to build on prior research and describe the current use of psychotropic medications among the first 365 older hospitalized patients living with dementia ...participating in a study focused on optimizing physical activity The Function Focused Care for Acute Care Using the Evidence Integration Triangle Study (FFC-AC-EIT) and consider the impact of current recommendations for decreasing use of psychotropics. It was hypothesized that controlling for age, gender, race, comorbidities, cognition, and hospital site (exposure or not to the Function Focused Care Intervention), that there would be a decrease in use of psychotropic medications from admission to discharge. Age, gender, race, comorbidities, admitting diagnosis, and medications (antidepressants, antianxiety medications, anticonvulsants, dementia drugs, antipsychotics, sedative-hypnotics, and opioids) were obtained at baseline and medications were obtained as well at discharge. To compare change over time generalized estimating equations were used. The participants were mostly female (63%), White (69%), and 83.06 years (SD=7.90) old. There was no treatment effect. Antidepressant, antianxiety, anticonvulsant, dementia medication, sedative hypnotic and opioid use remained unchanged. Antipsychotic medication use increased significantly from 16% to 21% at discharge. Some changes were made across drug groups such as change from haloperidol to second generation antipsychotics to decrease risk of side effects. A more focused deprescribing intervention is needed to best address psychotropic medication use among individuals living with dementia when hospitalized.
Abstract
To help acute care nurses learn to provide function focused care during care interactions the Function Focused Care intervention is implemented on nursing units. The Function Focused Care ...intervention is based on the Social Ecological Model, Social Cognitive Theory and the Evidence Integration Triangle and includes four components: (1) Development of a stakeholder team; (2) Education; (3) Development of functional care plans; and (4) Mentoring and motivating. Our nurse interventionist provides function focused care education as per the preference of the setting. Following education, direct observation during care interactions is done and the nurse interventionist provides recommendations related to the approach being used or provides positive reinforcement if function focused care is provided. The observation tool used to evaluate function focused care by the nursing staff includes 19 different care interactions (e.g., bathing, dressing, transferring). Guidelines are provided for what is and is not function focused care. In the first four treatment sites, at 2 months post implementation the nurses provided function focused care during 81% of the of care interactions observed, by 6 months this increased to 85% and by 10 months this increased to 88%. There was also a decline in the number of care interactions in which function focused care was not provided. The findings suggest that nurses can provide function focused care even during times of significant shortages and that continued oversight and education can help improve the use of this approach.
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.
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.
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.
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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