Improving morning care routines of nursing home residents with dementia.
Improving morning care routines of nursing home residents with dementia.
复制标题
改善患有痴呆症的疗养院居民的早晨护理程序。
DOI：
10.1111/j.1532-5415.1999.tb05226.x
复制
发表时间：
1999
影响因子：
6.3
通讯作者：
McDowell,BJ
中科院分区：
文献类型：
--
作者：
Rogers,JC;Holm,MB;Burgio,LD;Granieri,E;Hsu,C;Hardin,JM;McDowell,BJ
目的：本研究旨在探讨行为康复干预对改善老年痴呆症疗养院住院患者晨间护理日常生活活动（ADL）表现的有效性。设计：在自然护理（自然）和技能诱导（干预）条件下，对参与者及其护理人员进行为期5天的观察，并在习惯训练（干预随访）条件下进行为期15天的观察。观察结果涉及ADL类别，包括穿衣、其他ADL和无ADL。采用3 × 3设计（条件X ADL类别）。设置：观察发生在宾夕法尼亚州匹兹堡市的五家私人疗养院。参与者：参与者为58名女性和26名男性，平均年龄82岁（范围= 64-97，SD = 6.3），可能患有阿尔茨海默病（AD）（n = 19）和可能患有AD（n = 65），平均MMSE评分为6.07。条件2，技能启发，包括个性化的行为康复干预，旨在识别和引出保留的ADL技能。在条件3，习惯训练，行为康复干预继续加强和巩固保留的技能，并促进进一步的功能gains.MEASUREMENTS：一个计算机辅助数据收集系统被用来记录在真实的-时间的援助所使用的照顾者，参与者的日常生活能力的表现，和参与者的反应，包括破坏性行为。与日常护理相比，在技能启发期间，参与者参与无辅助和辅助穿衣的时间比例显着增加，并增加了他们对ADL的整体参与，伴随着破坏性行为的显著减少。这些功能的改善在开始行为康复干预的5天内得到证实，并在习惯训练期间维持3周。物理协助提供了一个上午的护理会话在技能启发和习惯训练的比例显着较小相比，与malticalCare.Conclusions：即使是非常严重的认知障碍和功能障碍的疗养院居民可以响应系统实施的行为康复干预。他们对这种干预的快速反应表明，它是减轻过度残疾所带来的照顾模式，而不是重新训练ADL任务的表现。患有痴呆症的居民通过更适当地参与他们的护理和减少破坏性而受益于行为康复。然而，行为康复护理比常规护理需要更多的时间。J Am Geriatr Soc 47：1049-1057，1999.
OBJECTIVES:This study examined the effectiveness of a behavioral rehabilitation intervention for improving the performance of morning care activities of daily living (ADL) of nursing home residents with dementia.DESIGN:Participants and their caregivers were observed for 5 days each under conditions of Usual Care (naturalistic) and Skill Elicitation (intervention), and for 15 days under Habit Training (intervention follow‐up). Observations involved the ADL categories of DRESSING, OTHER ADL, and NO ADL. A 3 × 3 design (condition X ADL category) was used.SETTING:Observations occurred in five proprietary nursing homes in Pittsburgh, Pennsylvania.PARTICIPANTS:The participants were 58 women and 26 men, mean age 82 years (range = 64–97, SD = 6.3), with Probable Alzheimer's disease (AD) (n = 19) and Possible AD (n = 65), with a mean MMSE score of 6.07.INTERVENTION:Condition 1, Usual Care, was the naturalistic caregiving condition. Condition 2, Skill Elicitation, consisted of an individualized behavioral rehabilitation intervention designed to identify and elicit retained ADL skills. Under Condition 3, Habit Training, the behavioral rehabilitation intervention was continued to reinforce and solidify retained skills and to facilitate further functional gains.MEASUREMENTS:A computer‐assisted data collection system was used to document in real‐time the assists used by caregivers, the participants' ADL performance, and the participants' responses to caregiving, including disruptive behavior.RESULTS:Compared with Usual Care, during Skill Elicitation participants increased the proportion of time engaged in nonassisted and assisted dressing significantly and increased their overall participation in ADL, with a concomitant significant decrease in disruptive behavior. These functional gains were demonstrated within 5 days of initiating the behavioral rehabilitation intervention and were maintained for 3 weeks during Habit Training. Physical assists were provided for significantly smaller proportions of a morning care session during Skill Elicitation and Habit Training compared with Usual Care.CONCLUSIONS:Even very severely cognitively impaired and functionally disabled nursing home residents can respond to a systematically implemented behavioral rehabilitation intervention. Their rapid response to this intervention suggests that it is alleviating excess disabilities brought on by care patterns rather than retraining ADL task performance. Residents with dementia benefit from behavioral rehabilitation by becoming more appropriately involved in their care and being less disruptive. However, behavioral rehabilitative care takes considerably more time than usual care. J Am Geriatr Soc 47:1049–1057, 1999.