Improving Morning Care Routines of Nursing Home Residents with Dementia
Dept. of Occupational Therapy, University of Pittsburgh, Pennsylvania 15260, USA. Journal of the American Geriatrics Society
(Impact Factor: 4.57).
10/1999; 47(9):1049-57. DOI: 10.1111/j.1532-5415.1999.tb05226.x
This study examined the effectiveness of a behavioral rehabilitation intervention for improving the performance of morning care activities of daily living (ADL) of nursing home residents with dementia.
Participants and their caregivers were observed for 5 days each under conditions of Usual Care (naturalistic) and Skill Elicitation (intervention), and for 15 days under Habit Training (intervention follow-up). Observations involved the ADL categories of DRESSING, OTHER ADL, and NO ADL. A 3 x 3 design (condition x ADL category) was used.
Observations occurred in five proprietary nursing homes in Pittsburgh, Pennsylvania.
The participants were 58 women and 26 men, mean age 82 years (range = 64-97, SD = 6.3), with Probable Alzheimer 's disease (AD) (n = 19) and Possible AD (n = 65), with a mean MMSE score of 6.07.
Condition 1, Usual Care, was the naturalistic caregiving condition. Condition 2, Skill Elicitation, consisted of an individualized behavioral rehabilitation intervention designed to identify and elicit retained ADL skills. Under Condition 3, Habit Training, the behavioral rehabilitation intervention was continued to reinforce and solidify retained skills and to facilitate further functional gains.
A computer-assisted data collection system was used to document in real-time the assists used by caregivers, the participants' ADL performance, and the participants' responses to caregiving, including disruptive behavior.
Compared with Usual Care, during Skill Elicitation participants increased the proportion of time engaged in nonassisted and assisted dressing significantly and increased their overall participation in ADL, with a concomitant significant decrease in disruptive behavior. These functional gains were demonstrated within 5 days of initiating the behavioral rehabilitation intervention and were maintained for 3 weeks during Habit Training. Physical assists were provided for significantly smaller proportions of a morning care session during Skill Elicitation and Habit Training compared with Usual Care.
Even very severely cognitively impaired and functionally disabled nursing home residents can respond to a systematically implemented behavioral rehabilitation intervention. Their rapid response to this intervention suggests that it is alleviating excess disabilities brought on by care patterns rather than retraining ADL task performance. Residents with dementia benefit from behavioral rehabilitation by becoming more appropriately involved in their care and being less disruptive. However, behavioral rehabilitative care takes considerably more time than usual care.
Available from: stir.ac.uk
- "hand-over-hand type prompting) . However, even people with relatively severe dementia can benefit from verbal prompting  . When a task is unfamiliar then physical modelling can be helpful, while a familiar task that requires visual attention may benefit most from verbal prompting . "
[Show abstract] [Hide abstract]
ABSTRACT: The aim was to support people with cognitive impairment through speech-based dialogues that guide them through everyday tasks such as activities of daily living. The research objectives were to simplify the design of prompting dialogues, to automate the checking of prompting dialogues for syntactic and semantic errors, and to automate the translation of dialogue designs into a form that allows their ready deployment.
Prompting dialogues are described using CRESS (Communication Representation Employing Systematic Specification). This is a notation and toolset that allows the flow in a service (such as a dialogue) to be defined in an understandable and graphical way. A dialogue diagram is automatically translated into a formal specification for rigorous verification and validation. Once confidence has been built in the dialogue design, the dialogue diagram is automatically translated into VoiceXML and deployed on a voice platform.
All key objectives of the work have been achieved. A variety of significant dialogues have been successfully represented using the CRESS notation. These dialogues have been automatically analysed through formal verification and validation in order to detect anomalies. Finally, the dialogues have been automatically realised on a VoiceXML platform and have been evaluated with volunteer users.
Journal of Biomedical Informatics 03/2011; 44(5):713-27. DOI:10.1016/j.jbi.2011.03.010 · 2.19 Impact Factor
Available from: Wendy Wood
- "To guide this study, we developed a theoretical rationale that integrated environmental, occupational, and QoL concepts found to be highly relevant to LTC residents with dementia. Primary influences included Brod, Steward, and Sands' (2000) dementia-specific model of QoL, Lawton's (1982, 1989; Lawton & Nahemow, 1973) ecological model of aging, classic works and contemporary practices in occupational therapy (Hellen, 1998; Meyer, 1922; Reilly, 1962; Yerxa, 1967; Zgola, 1987, 1999), and research in occupational therapy and occupational science (Hasselkus, 1998; Rogers et al., 1999; Wood, 1998a, 1998b, 2002; Wood, Towers, & Malchow, 2000). Together, these influences underscore the importance of an environmental perspective for understanding people's occupational lives. "
[Show abstract] [Hide abstract]
ABSTRACT: The objective of this instrumental case study was to explore interrelationships among routine activity situations on 2 Alzheimer's special care units (SCUs) and 2 resident quality-of-life (QoL) indicators: daily time use and emotional well-being. Fourteen residents participated. We collected data across four 12-hr days using computer-assisted direct observations and computed associations of activity situations with QoL indicators and mean durations of QoL indicators in activity situations and daily by facility. We compared mean durations of QoL indicators across facilities and analyzed time-use profiles of 2 residents. We found that participants' capacities for activity engagement and emotional vitality were infrequently expressed at both SCUs. Diminished QoL was attributable to participants' dementia-related impairments coupled with insufficient attention to their occupational needs, initiatives, and capacities. Findings call for occupational therapists' involvement as educators, mentors, and consultants to enhance the effectiveness of routine activity situations in promoting QoL through everyday occupations.
The American journal of occupational therapy.: official publication of the American Occupational Therapy Association 05/2009; 63(3):337-50. DOI:10.5014/ajot.63.3.337 · 1.70 Impact Factor
Available from: Kimberly Van Haitsma
- "Construct validity was demonstrated in the dementia population through sensitivity of positive behaviors to a video-respite intervention. The Computer-Assisted Data Collection (Burgio et al., 1994; Holm, Rogers, Burgio, & McDowell, 1999; Pollock et al., 1997; Rogers et al., 1999) focuses on the effects of multiple environmental factors, including staff behavior, on resident behavior. A laptop computer is used to record the frequency and duration of disruptive vocalizations, duration of activities of daily living (ADLs), number of caregiver assists, requests for help, and variables identifying environmental context. "
[Show abstract] [Hide abstract]
ABSTRACT: This review article reports on methods of direct observation of behaviors for use in long-term care settings, particularly with older adults who have dementia. This article provides information on the theoretical roots, administration methods, and psychometric properties of measures of direct observation of individual behavior. It is hoped that this review will help gerontological nurses make informed choices about the direct observation measures that suit their specific needs, highlight the role of direct observation in quality improvement for dementia care, and facilitate a balance between identifying a gold standard and allowing flexibility to assess project-specific behaviors.
Research in Gerontological Nursing 01/2008; 1(1):52-76. DOI:10.3928/19404921-20080101-02 · 0.64 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.