‘Knowing what makes them tick’: Motivating cognitively impaired older adults to participate in restorative care
Nursing home residents with dementia represent a majority of the most functionally impaired individuals residing in nursing homes. Although many perceive this population as having little restorative potential, maintaining resident functional abilities for as long as possible helps to optimize quality of life and decrease caregiver burden. This study used a qualitative design with a focus group methodology to explore facilitators and barriers to engaging cognitively impaired residents in functional activities and exercise. A purposive sample of seven geriatric nursing assistants who were experts in dementia care participated in the study. Twenty-seven codes were reduced to three themes: (i) knowing what makes them tick and move; (ii) teamwork and utilizing resources; and (iii) barriers to restorative care. The study findings were used to revise the Restorative Care for the Cognitively Impaired Intervention and could direct future implementation of programmes in nursing home settings.
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- "These studies focused on barriers and facilitators as perceived by nursing assistants. Barriers identified included refusal by residents, the lack of nursing support, and the assumption that residents could not perform activities [12, 20, 21] . In addition, barriers mentioned in questionnaires generally measuring barriers and facilitators provided input for the inventory. "
Available from: Wen Liu
- "Interactions by caregivers in these LTC settings are based on their perceptions, knowledge and beliefs that residents with dementia are unable to eat independently or that they are unable to ensure adequate caloric intake and thus these residents are inappropriately provided with excessive assistance (i.e. residents are fed vs. being allowed and encouraged to self-feed) (Chang & Lin 2005, Galik et al. 2009). In addition, many caregivers and family members believe that feeding an older adult is a way of being caring and nurturing (Chee 2000). "
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The aim of this study was to examine the association of specific personal and environmental factors with eating performance among long-term care residents with moderate-to-severe cognitive impairment.
Eating is the one of the most basic and easiest activities of daily living to perform. While multilevel factors can be associated with eating performance, the evidence among those with dementia was insufficient.
A secondary analysis of baseline data collected between March and September in 2012 from 199 residents in eight long-term care facilities.
Eating performance was conceptualized using the single self-care 'feeding' item in the Barthel Index and was scored based on four levels of dependence and assistance required. Binary logistic regression was used to examine the adjusted association of specific factors with eating performance.
Almost one-third of the residents needed help with eating. After adjusting the type of facility, number of comorbidities, chair-sitting balance, agitation and depression, compromised eating performance was associated with severe cognitive impairment and low physical capability.
This study supported the association of eating performance with cognitive impairment and physical capability among long-term care residents with moderate-to-severe cognitive impairment. Targeted interventions should be implemented to reduce the impact of cognitive decline on eating performance and promote physical capability to optimize eating performance. Future work need to use validated multiple-item measures for eating performance and test the association of personal and environmental factors with eating performance among a larger heterogeneous group of long-term care residents to enhance understanding of the factors.
- "It is seen as an add-on, a program that is parceled out and designated as specialized work in the purview of physiotherapists. The new finding this research contributes is a sophisticated analytical understanding into what has previously been discussed in the literature as discrete categorical barriers to physical activity (Resnick et al. 2006, 2008; Benjamin et al. 2009, 2011; Galik et al. 2009; Chen 2010; Kalinowski et al. 2012; Phillips and Flesner 2013). Typically, exercise programs in LTC homes in Canada are scheduled and delivered one to three times per week (Lazowski et al. 1999; Benjamin et al. 2011), which reinforces the idea of that daily physical activity is something separate from activities of daily living. "
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ABSTRACT: Worldwide, the literature reports that many residents in long-term care (LTC) homes are sedentary. In Canada, personal support workers (PSWs) provide most of the direct care in LTC homes and could play a key role in promoting activity for residents. The purpose of this institutional ethnographic study was to uncover the social organization of LTC work and to discover how this organization influenced the physical activity of residents. Data were collected in two LTC homes in Ontario, Canada through participant observations with PSWs and interviews with people within and external to the homes. Findings explicate the links between meals, lifts and transfers, and the LTC standards to reveal that physical activity is considered an add-on program in the purview of physiotherapists. Some of the LTC standards which are intended to product good outcomes for residents actually disrupt the work of PSWs making it difficult for them to respond to the physical activity needs of residents. This descriptive ethnographic account is an important first step in trying to find a solution to optimize real activities of daily living into life in LTC.
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