Function and Behavior Focused Care for Nursing Home Residents with Dementia

描述(由申请人提供)：对中度到严重认知障碍的疗养院居民的护理传统上遵循监管方法，护理人员专注于将行为问题降至最低，并在护理活动期间为这些人执行必要的功能任务。虽然不是故意的，但监护实践中更有可能发生护理抵抗、功能衰退、不能动的医疗并发症、过度使用精神药物和不良事件，如摔倒。因此，在中度到重度认知障碍的护理住院医师中实施非药物干预，以最大限度地减少行为障碍，优化身体功能，降低不良事件的风险是至关重要的。为了应对这些挑战，拟议的研究将检验认知障碍患者功能和行为重点护理(FBFC-CI)干预的有效性。FBFC-CI以社会生态学模型为基础，旨在通过激励和教授护理人员技能来改变他们的行为，以减少养老院痴呆症患者的行为症状，优化功能和身体活动。本研究的目的是测试FBFC-CI对中重度认知障碍居民的行为和功能结果的影响，并探索在设施水平上采取干预措施的情况。具体地说，我们将在12家养老院(每家养老院40名住院患者)的480名居民中进行整群随机试验，以实现以下目标：目的1.评估FBFC-CI对居民的行为症状(抑郁、抵抗护理、激越)、精神药物使用、功能(ADLS、表现)和体力活动(调查、活动记录)的有效性；目的2.评估FBFC-CI对不良事件(跌倒、急诊室入院和住院)的影响；以及目的3.展示工作人员对FBFC方法的采用和维护。居民将有中度到重度的认知障碍(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到重度痴呆症患者提供的护理方法的关键的下一步，以减少这些患者的行为症状，优化功能和体力活动，减少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.