Changing behavior in senior housing residents: testing of phase I of the PRAISEDD-2 intervention.

PURPOSE: Programs focused on health related behaviors implemented in senior centers, senior housing or churches have not been strongly successful in showing significant improvement in cardiovascular disease (CVD) prevention behaviors or important clinical outcomes such as decreasing blood pressure. The purpose of this study was to consider the feasibility and preliminary efficacy of phase I of the PRAISEDD-2 intervention. PRAISEDD-2 was implemented to increase physical activity, adherence to heart healthy diets and antihypertensive and/or lipid lowering medications. METHOD: This was a single site pre post intervention trial. The 12 week phase I activities included education, motivational interventions and exercise classes two times per week implemented by a lay trainer and nurse. RESULTS: A total of 29 residents were recruited from a single senior housing facility. The majority was Black or African American, female and had at least a high school education. The average age of participants was 74 years of age. At the end of phase I, participants had stronger outcome expectations for exercise, decreased fat and salt intake and decreased pain. There was a non-significant improvement in time spent in physical activity and distance walked in 6 minutes. CONCLUSION: Phase I of the PRAISEDD-2 intervention was feasible based on adherence to study design, training of the interventionists, delivery and receipt, and there was some support for efficacy across some study outcomes.

The impact of PRAISEDD on adherence and initiation of heart health behaviors in senior housing.

OBJECTIVE: Building on prior theoretical work and research, we developed a community-based intervention, People Reducing Risk And Improving Strength through Exercise, Diet, and Drug Adherence (PRAISEDD), a three-phase program which was implemented in 2009. The purpose of this study was to report on Phase III, the Inoculation Phase, of the PRAISEDD program and explore participant experiences. DESIGN AND SAMPLE: This was a descriptive, qualitative study focused on exploring participation in heart healthy PRAISEDD classes. Ten residents participated in the focus group, all of whom attended at least one PRAISEDD session. MEASURES: Qualitative data were obtained at the end of the 12 months during which Phase III was implemented. Descriptive data were gathered to describe the number of initial PRAISEDD participants and the number of new participants who came to classes. RESULTS: Nine codes were identified and reduced to two themes: motivators to participate in exercise classes; and factors that decrease willingness to participate. The Phase III monthly PRAISEDD inoculation classes were attended by 10-12 residents, the majority of whom participated in Phase I of PRAISEDD. CONCLUSION: We were able to engage new participants in classes during Phase III, and qualitative findings provided important recommendations for future work.

Application of the Antipsychotic Use in Dementia Assessment audit tool to facilitate appropriate antipsychotic use in long term care residents with dementia.

Approximately 25% of all nursing home residents take antipsychotics for behavioral disturbances, despite limited efficacy and warnings against their use. The purpose of this quality improvement project was to test the utility of an educational in-service to facilitate the appropriate use of antipsychotics for nursing home residents with dementia. A single group pre/post design targeting the reduction of antipsychotic medications in older adults was guided by Rogers' Diffusion of Innovations theory. Descriptive analyses were done to evaluate antipsychotic use and supporting documentation at baseline and 2 months following an educational intervention that focused on appropriate antipsychotic use, documentation requirements and non-pharmacologic interventions. The prescribing rate for antipsychotics showed a reduction from 20.3% to 15.4% and nursing documentation of non-pharmacological interventions increased from 16.7% to 75%. Assuring appropriate use of antipsychotics is currently mandated and is consistent with high quality, person centered care. This simple, yet individualized educational intervention and assessment can serve as a model for use in other long term care facilities.