PROGRAM HEAL--Activating the Lives of Older Adults

我们打算实施和测试的综合干预措施，以防止疗养院居民的功能障碍的有效性。 干预措施通过促进锻炼、采用和坚持以及扭转导致居民不活动的体制因素来发挥作用。 我们的计划，HEAL（“帮助老年人激活他们的生活”），代表了两种干预措施的整合，这两种干预措施独立于我们研究所内的不同理论模型。 一个选定的运动组成部分，渐进式阻力训练的基础上，促进养老院居民的行为改变，并已被证明是安全和有效的建设肌肉质量，改善基于性能的测试身体功能，改善和预防日常生活活动的下降。基于护理的普遍康复部分针对造成居民不活动问题的社会和环境因素。 我们已经表明，居民可以帮助更多的自我参与日常活动的性能，通过培训和鼓励护理规划的重定向到每个居民的功能能力，有针对性的护理人员和设施内的社会力量的行为。 这些干预措施中的每一项都被证明在独立实施时能有效预防功能性残疾。结合HEAL干预模式，该计划促进了从锻炼计划到养老院居民日常活动中获得的功能能力的连续性。 利用现有的工作人员在三个三胞胎匹配的设施，干预措施将在准实验性试验的范围内实施，涉及估计1,350名居民从随机分配的实验性运动，实验性运动和护理为基础的康复，和通常的护理控制之家。 将在基线和干预的第4、8、12和16个月收集功能状态、生理、情绪和自我效能指标的表现。 拟议研究的目的是确定这种干预在真实的世界环境中的有效性。 具体而言，我们假设干预将在近端起作用：1）促进居民锻炼行为，2）改善生理测试表现，3）远端起作用，以防止进一步的功能下降，促进功能改善。 此外，我们预计对情绪，幸福感，自我效能感和生活质量的结果有显着的影响。

We intend to implement and test the effectiveness of a comprehensive intervention to prevent functional disability among nursing home residents. The intervention acts by promoting exercise adoption and adherence and reversing institutional factors that cause resident inactivity. Our program, HEAL ('Helping Elders Activate their Lives'), represents an integration of two interventions developed independently from different theoretical models within our institute. A selected exercise component, based on progressive resistance training, promotes behavioral change among nursing home residents, and has been shown to be safe and efficacious in building muscle mass, improving performance-based tests of physical functioning, improving and preventing decline in activities of daily living. The universal nursing-based rehabilitation component targets social and environmental factors contributing to the problem of resident inactivity. We have shown that residents can be helped to be more self-involved in performance of daily activities by targeting behavior of nursing staff and social forces within the facility through training and encouraging a redirection of care planning towards each resident's functional capacity. Each of these interventions has been shown to be efficacious in preventing functional disability when implemented independently. Combined as the HEAL intervention model, the program facilitates the continuity of functional capacity gains resulting from the exercise program into the daily activity of nursing home residents. Making use of existing staffing at three triplets of matched facilities, the intervention will be implemented within the confines of a quasi-experimental trial, involving an estimated 1,350 residents from both randomly assigned experimental exercise only, experimental exercise and nursing based rehabilitation, and usual care control homes. Performance on functional status, and physiologic, mood and self-efficacy measures will be collected at baseline and months 4, 8, 12 and 16 of the intervention. The aim of the proposed study is to establish the effectiveness of this intervention acting in a real world setting. Specifically, we hypothesize that the intervention will act proximally in 1) promoting resident exercise behavior, 2) improve performance on physiologic tests, and 3) act distally to prevent further functional decline and facilitate functional improvement. Further, we anticipate significant carry over effects on mood, well-being, self-efficacy and quality of life outcomes.