A Cluster Randomized Controlled Trial Testing the Impact of Function and Behavior Focused Care for Nursing Home Residents With Dementia.

OBJECTIVE: The purpose of this study was to test the effectiveness of the Function and Behavior Focused Care for the Cognitively Impaired (FBFC-CI) intervention on function, physical activity, and behavioral symptoms among nursing home residents with dementia, and to explore the adoption of the intervention at the facility level. DESIGN: This study was a clustered, randomized controlled trial with a repeated measures design that was implemented in 12 nursing homes randomized to either treatment (FBFC-CI) or educational control [Function and Behavior Focused Care Education (FBFC-ED)]. SETTING AND PARTICIPANTS: Twelve nursing homes (6 treatment and 6 control) and 336 residents (173 treatment and 163 control) with moderate to severe cognitive impairment. MEASURES: Outcomes included functional ability (Barthel Index), physical activity (actigraphy and survey), behavioral symptoms (Resistiveness to Care Scale, Cohen-Mansfield Agitation Inventory, Cornell Scale for Depression in Dementia), and psychotropic medication use. RESULTS: The participants were 82.6 (SD = 10.1) years of age, mostly female, and were moderate to severely cognitively impaired (Mini-Mental State Exam of 7.8, SD = 5.1). There was a significantly greater increase in time spent in total activity (P = .004), moderate activity (P = .012), light activity (P = .002), and a decrease in resistiveness to care (P = .004) in the treatment versus control group at 4 months. There was no change in mood, agitation, and the use of psychotropic medications. There was some evidence of adoption of the intervention at treatment sites. CONCLUSIONS AND IMPLICATIONS: This study provides some support for the use of the FBFC-CI Intervention to increase time spent in physical activity and decrease resistive behaviors during care commonly noted among nursing home residents with moderate to severe cognitive impairment.

'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.

Pilot testing of the restorative care intervention for the cognitively impaired.

OBJECTIVE: The objective of this study was to test the feasibility and impact of a 2-tiered motivational intervention, the Restorative Care Intervention for the Cognitively Impaired (Res-Care-CI), on nursing home residents with moderate to severe cognitive impairment. DESIGN: Single-group repeated measures study. PARTICIPANTS AND SETTING: Participants were 46 nursing home residents with moderate to severe cognitive impairment at a single nursing home designed for individuals with dementia. MEASUREMENTS: Descriptive data, the Barthel Index, the Physical Activity Survey in Long-Term Care, actigraphy, the Cornell Scale for Depression in Dementia, and the Cohen-Mansfield Agitation Inventory (short form). RESULTS: There was significant improvement in resident mood (F = 3.26, P = .02) and behavioral symptoms (F = 3.21, P = .04), but no significant change in physical function (F = 0.897, P = .43) or overall reported physical activity (F = 0.931, P = .43). There was a significant decrease in physical activity measured by actigraphy in 35 participants (F = 4.93, P = .005). CONCLUSIONS: Restorative care interventions were feasible to implement, and demonstrated improvements in mood and behavior, when used with nursing home residents with moderate to severe cognitive impairment.