Nurse Faculty Scholars - Gerontology

Adverse events associated with the Res-Care Intervention.

kdeming — Tue, 05 Jul 2011 15:32:49 +0000

Published Date:

Thu, 2010-09-30 (All day)

The purpose of this secondary data analysis was to evaluate the adverse events associated with a restorative care intervention (Res-Care) in nursing home (NH) residents. A randomized controlled repeated-measure design and generalized estimating equations were used to evaluate status at baseline and 4 and 12 months after initiation of the Res-Care Intervention. The Res-Care Intervention was a 2-tiered self-efficacy-based intervention focused on motivating nursing assistants to actively engage residents in functional and physical activities. The measurements included baseline (2-month pre-intervention), 4-month, and 12-month records of adverse events, including falls, fall-related injuries, fractures, emergency room (ER) visits, hospital admissions, and death abstracted from NH records. The results showed that there were significant baseline differences between treatment groups in resident race (more African Americans in control sites) and ER visits (more visits in treatment sites 2 months before intervention). Longitudinal models revealed significant differences in ER visits at 4 months and number of fallers at 12 months that were in the direction of a protective effect of treatment over time. The study concluded that The Res-Care Intervention, which maximizes physical functioning, is safe to conduct in NH residents and does not result in increased risks of falling, injury, or other adverse events.

Examining mindfulness-based stress reduction in older adults.

kdeming — Tue, 05 Jul 2011 15:07:08 +0000

Published Date:

Tue, 2011-05-31 (All day)

Mindfulness-based stress reduction (MBSR) programs are becoming increasingly common, but have not been studied in low income minority older populations. The purpose of this study was to understand which parts of MBSR were most important to practicing MBSR members of this population, and to understand whether they apply their training to daily challenges. There were three focus groups with 13 current members of an MBSR program. Participants were African American women over the age of 60 in a low-income housing residence. Each session was tape recorded and subsequently used inductive content analysis to identify primary themes.

Analysis of the focus group responses revealed three primary themes stress management, applying mindfulness, and the social support of the group meditation. The stressors they cited using MBSR with included growing older with physical pain, medical tests, financial strain, and having grandchildren with significant mental, physical, financial or legal hardships. It was found that participants particularly used their MBSR training for coping with medical procedures, and managing both depression and anger. In conclusion, a reflective stationary intervention delivered in-residence could be an ideal mechanism to decrease stress in low-income older adult's lives and improve their health.

Effects of Tai Chi and Western exercise on physical and cognitive functioning in healthy community-dwelling older adults.

lsharp — Wed, 20 Oct 2010 11:49:09 +0000

Published Date:

Thu, 2010-07-01 (All day)

METHODS: TC and WE involved combined class and home-based protocols. Physical functioning included balance, strength, flexibility, and cardiorespiratory endurance. Cognitive functioning included semantic fluency and digit-span tests. Data were analyzed using intention-to-treat analysis.

RESULTS: At 6 mo, WE had greater improvements in upper body flexibility (F = 4.67, p = .01) than TC and C. TC had greater improvements in balance (F = 3.36, p = .04) and a cognitive-function measure (F = 7.75, p < .001) than WE and C. The differential cognitive-function improvements observed in TC were maintained through 12 mo.

CONCLUSION: The TC and WE interventions resulted in differential improvements in physical functioning among generally healthy older adults. TC led to improvement in an indicator of cognitive functioning that was maintained through 12 mo.

OBJECTIVE: To compare the effects of Tai Chi (TC, n = 37) and Western exercise (WE, n = 39) with an attention-control group (C, n = 56) on physical and cognitive functioning in healthy adults age 69 +/- 5.8 yr, in a 2-phase randomized trial.
METHODS: TC and WE involved combined class and home-based protocols. Physical functioning included balance, strength, flexibility, and cardiorespiratory endurance. Cognitive functioning included semantic fluency and digit-span tests. Data were analyzed using intention-to-treat analysis.

Validation of the Stanford Brief Activity Survey: examining psychological factors and physical activity levels in older adults.

lsharp — Wed, 20 Oct 2010 11:46:40 +0000

Published Date:

Fri, 2010-01-01 (All day)

BACKGROUND: This study examined the construct validity and reliability of the new 2-item Stanford Brief Activity Survey (SBAS).

METHODS: Secondary analysis was conducted using data collected from the healthy older controls (n = 1023) enrolled in the Atherosclerotic Disease Vascular Function and Genetic Epidemiology (ADVANCE) study. Construct validity was examined by regression analyses to evaluate significant trends (P < or = .05) across the SBAS activity categories for the selected psychological health factors measured at baseline and year 2, adjusted for gender, ethnicity and education level. Test-retest reliability was performed using Spearman's rank correlation.

RESULTS: At baseline, subjects were 66 +/- 2.8 years old, 38% female, 77% married, 61% retired, 24% college graduate, and 68% Caucasian. At baseline, lower self-reported stress, anxiety, depression, and cynical distrust, and higher self-reported mental and physical well-being were significantly associated with higher levels of physical activity (p trend < or = 0.01). These associations held at year 2. The test-retest reliability of the SBAS was statistically significant (r(s)= 0.62, P < .001).

CONCLUSION: These results provide evidence of the construct validity and reliability of the SBAS in older adults. We also found a strong dose-response relationship between regular physical activity and psychological health in older adults, independent of gender, education level and ethnicity.

BACKGROUND: This study examined the construct validity and reliability of the new 2-item Stanford Brief Activity Survey (SBAS).

Function-Focused Care for LTC Residents with Moderate-to-Severe Dementia: A Social Ecological Approach

lsharp — Tue, 19 Oct 2010 13:29:52 +0000

Published Date:

Tue, 2010-06-15 (All day)

Over one-third of long-term care (LTC) residents exhibit moderate-to-severe cognitive impairment. These residents are more likely to be inactive, require assistance with activities of daily living, have medical comorbidities, and be exposed to fewer opportunities to engage in functional and physical activities than peers who are cognitively intact or have only mild cognitive deficits. This article will discuss factors that influence the functional performance of older adults with dementia, and benefits and barriers to implementing a function-focused philosophy of care for LTC residents with dementia. Specific strategies for implementation of function-focused care with this population will be described using a social ecological framework. (Annals of Long-Term Care: Clinical Care and Aging 2010;18[6]:27-32) Alzheimer’s disease (AD) and other related dementia syndromes present a significant public health problem for the aging population in the United States. Given the progressive deterioration in cognitive and functional abilities associated with the majority of dementia syndromes, it is estimated that by the year 2020, more than 3 million older adults with moderate-to-severe cognitive impairment will require nursing home (NH) care. Even without the impact of acute illness, significant decline in functional abilities, including bed mobility, transfer, locomotion, dressing, eating, toileting, and personal hygiene, occurs within six months among NH residents with moderate and severe cognitive impairment.

Satisfaction with Assisted Living: The Unexplored Role of Physical Activity

lsharp — Tue, 19 Oct 2010 13:21:48 +0000

Published Date:

Sat, 2010-05-01 (All day)

In the ongoing Interdisciplinary Nursing Quality Research Initiative Program study, we are testing the impact of Function-Focused Care, which is an approach to care in which we work with assisted living (AL) residents and staff to optimize the functional and physical activities of residents during daily activity. The purpose of this article is to evaluate life satisfaction of AL residents with a focus on the impact of physical activity. In a sample of 171 older adults from 4 ALs, it was found that depression, social support from friends and experts, time in caregiving, and fear of falling all had a significant relationship with life satisfaction in AL. Physical activity was not related to life satisfaction in this study. Ongoing research is necessary to explore whether changing attitudes about physical activity among older adults and increasing social support related to physical activity can improve life satisfaction.

Pilot Testing of the Restorative Care Intervention for the Cognitively Impaired

nfs — Tue, 13 Jul 2010 13:12:46 +0000

Published Date:

Mon, 2008-09-01 (All day)

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

Barriers and Benefits to Implementing a Restorative Care Intervention in Nursing Homes

nfs — Tue, 13 Jul 2010 13:09:47 +0000

Published Date:

Fri, 2008-02-01 (All day)

OBJECTIVES: This study considered the factors that facilitated or prevented nursing assistants (NAs) from engaging in restorative care activities. DESIGN: This was a qualitative study using a focus group methodology. SETTING: Study participants were recruited from 6 nursing homes. PARTICIPANTS: Participants were nursing assistants (NAs) from a study testing the implementation of a restorative care intervention (Res-Care) study. Of the 244 NAs recruited from the 6 treatment sites, 179 were available at 12 months and 93 (52%) participated in the study. MEASUREMENT: An interview guide was used during each of the focus groups. Data analysis was done using basic content analysis. RESULTS: Sixty-one codes were identified and reduced to 4 themes: facilitators of restorative care; barriers to restorative care; benefits of restorative care; and sustaining restorative care. CONCLUSION: The findings provide an important NA perspective with regard to implementation of a restorative philosophy of care and provide recommendations for future work in this area.

Restorative Care With Cognitively Impaired Older Adults Moving Beyond Behavior

nfs — Tue, 13 Jul 2010 13:02:08 +0000

Published Date:

Fri, 2007-06-01 (All day)

More than half of individuals diagnosed with dementia experience significant functional limitations. A restorative philosophy of care focuses on the restoration and/or maintenance of physical function and helps older adults to compensate for functional impairments so the the highest level of function is obtained and complications of physical dependance are minimized. When working with cognitively impaired individuals who commonly exhibit behavioral and psychiatric symptoms, it is essential ti move beyond the tendancy to focus only on behavioral interventions, and also implement a restorative philosophy of care that maxinizes physical function and quality of life. This article describes a 4-step approach that can be used to implement a restorative philosophy of care for older adults with cognitive impairment and their caregivers.