Dissemination and Implementation of Function Focused Care for Assisted Living
- Conditions
- DementiaPain
- Interventions
- Behavioral: Function Focused Care
- Registration Number
- NCT03459118
- Lead Sponsor
- University of Maryland, Baltimore
- Brief Summary
This study will evaluate pain, management of pain, behavioral symptoms, and the quality of staff-resident interactions between residents with and without dementia, test the relationship of these variables to participation in function focused care at baseline, and consider if there is a differential impact of FFC-AL-EIT between those with and without dementia with regard to participation in function focused care, functional outcomes and physical activity over the 12 month study period. Findings from this study will provide new information on how to optimize function and physical activity among older adults with dementia in assisted living.
- Detailed Description
Estimates derived from National data indicate that seven out of ten residents in assisted living have some form of dementia, with 29% having mild impairment, 23% with moderate impairment, and 19% with severe impairment. More than one-third of these residents display behavioral symptoms commonly associated with dementia, approximately 30-50% experience pain, the majority require assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs), are sedentary and have limited opportunities to engage in physical activity. Innovative approaches are needed to help residents with dementia remain in assisted living settings. Typically, however, the care of older adults with dementia living in assisted living settings has followed a "just get it done" approach. The focus of care is on task completion and minimization of behavioral symptoms. This results in care that ignores what the resident is able to do for him or herself and is custodial. Residents are not encouraged to perform activities such as combing their own hair, brushing their teeth, or ambulating. Providing custodial care facilitates a decline in physical capability and function, causes medical complications, exacerbates depressive symptoms, increases the likelihood of sustaining a fall and ultimately may result in a need to be transferred to acute or skilled nursing care. To overcome custodial care we use an approach referred to as Function Focused Care. Function Focused Care is a philosophy of care in which staff members engage residents in physical activity at their highest level of ability during all care interactions. Prior research has repeatedly supported the effectiveness of Function Focused Care in terms of maintaining function and increasing time spent in physical activity among older adults in assisted living settings. We do not know, however, if: (1) there is a difference between those with and without dementia in pain, pain management, behavioral and affective symptoms, or the quality of staff-resident interactions; (2) these factors are associated with participation in function focused care activities at baseline; or (3) there is a differential impact of the Function Focused Care for Assisted Living using the Evidence Integration Triangle Intervention (FFC-AL-EIT) between those with and without dementia in terms of participation in function focused care activities, function and physical activity over the 12 month study period. To answer these questions we propose adding measures for pain, behavioral and affective symptoms and quality of staff-resident interactions to Cohort 2 of the parent study, Testing the Dissemination and Implementation of Function Focused Care (1R01AG050516-01A1). The findings from this study will add to what is currently known about older adults with dementia in assisted living and will be used to revise the FFC-AL-EIT intervention as needed to optimize participation in function focused care activities and thereby maintain and improve function and physical activity among older adults with dementia in assisted living.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 853
Residents are eligible to participate if: (1) they are living in a participating assisted living setting and are 65 years of age or older; (2) score at least a one out of three on the three out of three word recall question within the Minicog; and (3) are not enrolled in Hospice.
Residents will be excluded from the study if they are younger than 65 years of age and do not answer at least one out of three on the three out of three word recall question within the minicog.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Function Focused Care Function Focused Care FFC-AL-EIT is implemented by a Research Nurse Facilitator working with the champion and stakeholders using our four step approach: (I) Environment and Policy Assessments; (II) Education; (III) Establishing Resident Function Focused Care Service Plans; and (IV) Mentoring and Motivating. Education Only Function Focused Care Education only sites are exposed to Step II of the Four step approach described under the treatment arm. They receive baseline education of staff.
- Primary Outcome Measures
Name Time Method Cornell Scale for Depression in Dementia baseline a 19 item survey that assesses depressive symptoms
Quality of Interaction Scale baseline Observation scale of the positive and negative interactions between staff and residents
PAINAD baseline an observation measure of pain for individuals with cognitive impairment
The Barthel Index baseline A 10-item observation measure of basic activities of daily living
Function Focused Care Behavioral Checklist for Residents baseline a 19-item measure that addresses performance by the resident of function focused care
Resistiveness to Care baseline 13 item Likert observation scale of resistiveness to care
Checklist for Evidence of Use of Function Focused Care in the Service Plan baseline Addresses four areas focused on function in the resident's care plan
Motionwatch 8 baseline Actigraphy collected for a 5 day period with three full days of data used
Pain Verbal Descriptor Scale baseline Pain scale that allows respondent to state pain intensity and location
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (2)
Penn State University
🇺🇸State College, Pennsylvania, United States
University of Maryland
🇺🇸Baltimore, Maryland, United States