Testing the Efficacy of FFC-AC-EIT in Patients with Alzheimers Disease and Related Dementias

患有阿尔茨海默病和相关痴呆症（ADRD）的老年人约占25%， 住院的老年人。这些个体的功能下降、谵妄、福尔斯， 与痴呆相关的行为症状（BPSD）和更长的住院时间。期间身体活动 住院治疗（例如，行动、洗澡、穿衣）对老年人有积极的影响，包括预防 功能下降，疼痛减轻，谵妄减少，BPSD减少，福尔斯减少，住院时间缩短， 非计划的再次入院尽管已知的好处，体育活动并不鼓励常规， 老年住院病人80%以上的急症护理时间是在床上度过的。增加体力的挑战 老年ADRD患者的活动包括环境和政策问题（例如，无法进入一些地区， 护士对如何评估、预防和管理谵妄和BPSD缺乏了解; 系绳使用不当;患者、家属和护士认为卧床休息有助于康复， 防止福尔斯;以及患者缺乏下床的动机/意愿。增加身体活动， 预防功能下降，而住院，我们开发了功能为重点的急性护理（FFC-AC- EIT）。FFC-AC-EIT的实施改变了护士提供护理的方式 教导、提示和帮助ADRD患者在所有护理互动中进行体力活动。FFC-AC-EIT 是使用社会生态模型，社会认知理论和证据整合三角。 它涉及四个步骤，包括：（1）环境和政策评估;（2）教育;（3） 建立病人目标;（4）指导和激励员工、病人和家属。的目的 本研究是在马里兰州和宾夕法尼亚州的12家医院随机测试FFC-AC-EIT的疗效 至FFC-AC-EIT或仅功能集中护理教育（EO），每家医院招募50例患者（总计 样本600名患者）。目标1将侧重于主要基于体力活动的患者水平的疗效， 功能和参与功能集中护理，其次是谵妄、BPSD、疼痛、福尔斯、使用 系留和住院时间;以及所有这些结果（住院时间和系留除外）沿着紧急情况 出院后1个月、6个月和12个月的病房访视、再次住院和新的长期护理入院;以及 在单位一级，目标是评估FFC-AC-EIT对政策和环境的影响， 实施后6、12和18个月的功能和身体活动。随机分配至FFC-AC的医院- 将EIT与随机分配至仅功能集中护理教育（EO）组的患者进行比较。目标2将 基于治疗保真度（交付、接收、制定）136以及相对成本和费用，评估可行性 FFC-AC-EIT相对于EO的节省。调查结果将涉及几个优先研究领域： ADRD;改善身体功能;培训医院工作人员，并将证明方法的有效性 护理ADRD患者，可以在所有急诊护理机构传播和实施。

Older adults with Alzheimer’s Disease and Related Dementias (ADRD) comprise approximately 25% of hospitalized older adults. These individuals are at increased risk for functional decline, delirium, falls, behavioral symptoms associated with dementia (BPSD) and longer lengths of stay. Physical activity during hospitalization (e.g., mobility, bathing, dressing) has a positive impact on older adults including prevention of functional decline, less pain, less delirium, less BPSD, fewer falls, shorter length of stay and decreased unplanned hospital readmissions. Despite known benefits, physical activity is not routinely encouraged and older hospitalized patients spend over 80% of their acute care stay in bed. Challenges to increasing physical activity among older patients with ADRD include environment and policy issues (e.g., lack of access to areas to walk); lack of knowledge among nurses on how to evaluate, prevent and manage delirium and BPSD; inappropriate use of tethers; beliefs among patients, families, and nurses that bed rests helps recovery and prevents falls; and lack of motivation/willingness of patients to get out of bed. To increase physical activity and prevent functional decline while hospitalized we developed Function Focused Care for Acute Care (FFC-AC- EIT) for patients with ADRD. Implementation of FFC-AC-EIT changes how care is provided by having nurses teach, cue, and help patients with ADRD engage in physical activity during all care interactions. FFC-AC-EIT was developed using a social ecological model, social cognitive theory and the Evidence Integration Triangle. It involves a four-step approach that includes: (1) Environment and Policy Assessments; (2) Education; (3) Establishing Patient Goals; and (4) Mentoring and Motivating of Staff, Patients and Families. The purpose of this study is to test the efficacy of FFC-AC-EIT within 12 hospitals in Maryland and Pennsylvania randomized to FFC-AC-EIT or Function Focused Care Education Only (EO) with 50 patients recruited per hospital (total sample 600 patients). Aim 1 will focus on efficacy at the patient level based primarily on physical activity, function, and participation in function focused care, and secondarily on delirium, BPSD, pain, falls, use of tethers, and length of stay; and all of these outcomes (except length of stay and tethers) along with emergency room visits, re-hospitalizations and new long term care admissions at 1, 6 and 12 months post discharge; and at the unit level the aim is to evaluate the impact of FFC-AC-EIT on policies and environments that facilitate function and physical activity at 6, 12 and 18 months post implementation. Hospitals randomized to FFC-AC- EIT will be compared with those randomized to Function Focused Care Education Only (EO). Aim 2 will evaluate the feasibility, based on treatment fidelity (delivery, receipt, enactment)136, and relative cost and cost savings of FFC-AC-EIT versus EO. Findings will address several prioritized areas of research: a focus on ADRD; improving physical function; and training of hospital staff and will demonstrate efficacy of an approach to care for patients with ADRD that can be disseminated and implemented across all acute care facilities.