ABSTRACT
BACKGROUND: Non-pharmacologic programs can improve function and quality of life in people with memory loss (PWML), but in-person programs are not available in many communities. We previously developed the interactive, livestreaming, group-based, Moving TogetherTM program for PWML and their caregivers (CGs). This study assesses feasibility, satisfaction, and qualitative outcomes in four groups that participated during the COVID-19 pandemic. METHOD: We assessed feasibility based on number of participants and attendance. We administered an online survey at the end of the 12-week program to assess satisfaction. The survey included a 6-item Class Experience scale (e.g., feeling accepted, energized) and the 4-item PROMIS Social Isolation scale, both using 4-point Likert response scales. Open-ended questions asked about changes noticed in themselves and others during the program. We used a previously established coding scheme informed by a biopsychosocial framework to code free-text survey responses and refined codes as we identified new concepts. RESULTS: We offered four 12-week class series (1 hour, 2 days/week) from April to July 2020 that included 8 to 14 participants each (total N=39: 24 PWML, 15 CGs). Average attendance was 78% (range: 58% to 98%). Surveys were sent to 31 participants who completed the program, of whom 25 (16 PWML, 9 CGs) responded. Nearly all respondents reported that they often, mostly or always felt acceptance and well-being during classes (6-items, 88% to 100%), and most reported that they rarely or never felt social isolation (4 items, 50% to 100%). Qualitative analyses of free-text responses identified self-reported improvements in both PWML and CGs in several areas: 1) emotional well-being, including better mood, lower stress, and increased relaxation;2) social connection, such as friendship and camaraderie;3) physical function, including more energy, increased activity, improved movement, and increased mind-body awareness;and 4) cognitive function such as better focus. CONCLUSION: This study demonstrates that the interactive, livestreaming, group-based, Moving TogetherTM program is feasible and associated with high satisfaction among both PWML and their CGs. Technology offers tremendous potential to increase accessibility to evidence-based, non-pharmacologic programs that people with memory loss (PWML) and caregivers (CGs) can participate in from the safety of their homes. © 2021 the Alzheimer's Association.
ABSTRACT
Background: Implementation of non-pharmacologic programs for people with dementia is often challenging in skilled nursing facilities (SNFs). We previously implemented Preventing Loss of Independence through Exercise (PLIÉ)-an integrative, group movement program for SNF residents with dementia-at the San Francisco VA. This study aimed to identify barriers and facilitators to implementing PLIÉ in VA SNFs nationally. Methods: We conducted a formative evaluation using semi-structured interviews with key stakeholder groups (SNF staff, SNF directors, and VA health system leaders). Questions focused on PLIÉ's fit with current dementia programs and VA policies, characteristics of individual SNFs, and training and implementation strategies. We used rapid qualitative analyses to identify key barriers and facilitators to inform implementation activities. Results: We interviewed 23 people from geographically diverse VA SNFs and national program offices (SNF staff, n=14;SNF directors, n=3;Health system leaders, n=7). Barriers to implementing PLIÉ included: 1) Staff turnover and limited dementia experience;2) Space restrictions and limits on group size (e.g. quarantine periods);and 3) technical issues with training staff remotely. Implementation facilitators for PLIÉ included: 1) compatibility with SNF needs and goals (e.g. maintaining function, reducing disruptive behavior);2) adaptability (e.g., engaging residents with limited mobility, using individual instruction during the COVID-19 pandemic);3) engaging and training interprofessional staff;and 4) alignment with national VA priorities and programs for dementia care. Conclusions: Successful implementation of evidence-based, non-pharmacologic programs such as PLIÉ is facilitated by compatibility, adaptability, interprofessionalism and alignment with VA priorities while barriers are related to staff, space, and technology. PLIÉ's adaptability suggests it is a scalable model for increasing access to non-pharmacologic dementia programs that can serve large numbers of SNF residents. These findings will inform the development of a remote training program for SNF staff to become instructors and facilitate national spread to other VA SNFs.