Function and Behavior Focused Care for Nursing Home Residents with Dementia

描述（由申请人提供）：对中度至重度认知障碍的养老院居民的护理传统上遵循一种监护方法，护理人员专注于最小化行为问题，并在护理活动中为这些人执行必要的功能任务。虽然无意中，对护理的抗拒、功能下降、行动不便的医疗并发症、精神药物的过度使用和跌倒等不良事件更有可能在拘留护理中发生。因此，对中度至重度认知功能障碍的护理人员实施非药物干预，以减少行为障碍，优化身体功能，降低不良事件的风险至关重要。为了解决这些挑战，本研究将测试功能和行为重点护理对认知障碍（FBFC-CI）干预的有效性。FBFC-CI基于社会生态模型，旨在通过激励和教授护理人员减少痴呆症患者行为症状和优化功能和身体活动的技能来改变护理人员的行为。本研究的目的是测试FBFC-CI对中重度认知障碍住院患者行为和功能结局的影响，并探讨在机构层面采用干预措施。具体而言，我们将在12家养老院的480名居民（每家养老院40名居民）的随机试验中实施FBFC-CI，以实现以下目标：评估FBFC-CI对住院患者行为症状（抑郁、护理抵抗、躁动）、精神药物使用、功能（ADLs、表现）和身体活动（调查、活动记录仪）的有效性；目标2。评估FBFC-CI对不良事件（跌倒、急诊室入院和住院）的影响；和Aim 3。示范员工采用和维持使用FBFC方法。住院患者将有中度至重度认知障碍（MMSE d 15），数据将在基线、4个月和12个月收集。这项研究将是描述如何改变为中重度痴呆症患者提供的护理方法的关键下一步，以减少行为症状，优化功能和身体活动，减少这些个体不适当的精神药物使用和不良事件。

DESCRIPTION (provided by applicant): The care of nursing home residents with moderate to severe cognitive impairment has traditionally followed a custodial approach where nursing staff focus on minimizing behavioral problems and perform necessary functional tasks for these individuals during care activities. While unintended, resistance to care, functional decline, medical complications of immobility, and overuse of psychotropic medications and adverse events, such as falls, are more likely to occur with custodial care practices. Therefore, it is critical to implement non-pharmacological interventions to minimize behavioral disturbance, optimize physical function, and decrease the risk of adverse events among nursing residents with moderate to severe cognitive impairement.To address these challenges, the proposed study will test the effectiveness of the Function and Behavior Focused Care for the Cognitively Impaired (FBFC-CI) Intervention. FBFC-CI is based on a socioecological model and is designed to change nursing staff behavior by motivating and teaching them skills to decrease behavioral symptoms and optimize function and physical activity among nursing home residents with dementia. The aims of this study are to test the impact of FBFC-CI on both behavioral and functional outcomes of residents with moderate to severe cognitive impairment and explore the adoption of the intervention at the facility level. Specifically, we will implement FBFC-CI in a cluster randomized trial of 480 residents in twelve nursing homes (40 residents per nursing home) to accomplish the following aims: Aim 1. Evaluate the effectiveness of FBFC-CI on behavioral symptoms (depression, resistance to care, agitation), psychotropic medication use, function (ADLs, performance), and physical activity (survey, actigraphy) of residents; Aim 2. Evaluate the impact of FBFC-CI on adverse events (falls, emergency room admissions and hospitalizations); and Aim 3. Demonstrate staff adoption and maintenance of use of FBFC approaches. Residents will have moderate to severe cognitive impairment (MMSE d 15) and data will be collected at baseline, 4, and 12 months. This study will be a critical next step in delineating how to change care approaches provided to residents with moderate to severe dementia so as to decrease behavioral symptoms, optimize function and physical activity and decrease inappropriate psychotropic medication use and adverse event experienced by these individuals.