PROGRAM HEAL--Activating the Lives of Older Adults

我们打算实施和测试综合干预的有效性，以防止功能残疾的养老院居民。干预的作用是促进锻炼的采用和坚持，扭转导致居民缺乏运动的制度因素。我们的项目，HEAL（帮助老年人激活他们的生活），代表了两种干预的整合，这些干预独立于我们研究所不同的理论模型。一种基于渐进式阻力训练的精选运动组成部分，促进了养老院居民的行为改变，并已被证明在增强肌肉质量、改善基于性能的身体功能测试、改善和预防日常生活活动下降方面是安全有效的。普遍以护理为基础的康复部分针对导致居民缺乏活动问题的社会和环境因素。我们已经证明，通过培训和鼓励将护理计划转向每位居民的功能能力，针对护理人员的行为和设施内的社会力量，可以帮助居民更多地参与日常活动。当单独实施时，这些干预措施中的每一项都已被证明在预防功能性残疾方面是有效的。与HEAL干预模式相结合，该项目促进了从锻炼项目中获得的功能能力的连续性，并将其融入到养老院居民的日常活动中。利用三个匹配设施的现有人员，干预措施将在准实验试验的范围内实施，涉及大约1,350名居民，他们分别来自随机分配的实验性锻炼、实验性锻炼和基于护理的康复以及常规护理对照家庭。将在基线和干预的第4、8、12和16个月收集功能状态、生理、情绪和自我效能的表现。本研究的目的是在现实环境中确定这种干预措施的有效性。具体来说，我们假设干预将在近端起作用：1)促进居民的运动行为，2)提高生理测试的表现，以及3)在远端起作用，以防止进一步的功能下降并促进功能改善。此外，我们预计在情绪、幸福感、自我效能和生活质量方面会产生显著的传递效应。

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.