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

测试 FFC-AC-EIT 对阿尔茨海默病和相关痴呆症患者的疗效

• 批准号: 10353374
• 负责人: Marie Boltz
• 金额: $ 46.57万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10353374
• 关键词: Abnormal coordination; Acute; Address; Admission activity; Adverse event; Age; Age-Years; Alzheimer' s Disease; Alzheimer' s disease related dementia; Area; Bathing; Bed rest; Beds; Behavioral Symptoms; Belief; Caring; Cognitive; Cost Savings; Cues; Deep Vein Thrombosis; Deimplementation; Delirium; Dementia; Discipline of Nursing; Disease; Education; Elderly; Emergency department visit; Environment; Event; Fall prevention; Family; Family Nursing; Fright; Goals; Health care facility; Healthcare Systems; Hospital Units; Hospitalization; Hospitals; Individual; Institutionalization; Knowledge; Length of Stay; Licensed Practical Nurse; Long-Term Care; Maryland; Medical; Mental Depression; Mentors; Methods; Modeling; Moods; Motivation; Movement; Nurses; Nursing Staff; Outcome; Pain; Patient Care; Patient Participation; Patient Recruitments; Patients; Pennsylvania; Physical Function; Physical activity; Physical assessment; Pilot Projects; Pneumonia; Policies; Prevention; Process; Quality of life; Randomized; Recovery; Registered nurse; Research; Resources; Risk; Sampling; Sterile coverings; System; Testing; Training; Urinary tract infection; Walking; Work; acute care; adverse event risk; adverse outcome; associated symptom; base; care coordination; caregiving; comorbidity; cost; disability; effective intervention; efficacy testing; experience; fall risk; falls; fear of falling; functional decline; hospital readmission; implementation framework; implementation intervention; improved; innovation; medication administration; novel strategies; older patient; person centered; post implementation; prevent; psychological symptom; readmission rates; recruit; relative cost; social; social cognitive theory; vehicular accident; willingness

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.

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。这些人出现功能衰退、谵妄、跌倒的风险增加， 与痴呆（BPSD）相关的行为症状和更长的住院时间。期间的体力活动 住院（例如活动、洗澡、穿衣）对老年人有积极影响，包括预防 功能下降、疼痛减轻、谵妄减少、BPSD 减少、跌倒减少、住院时间缩短和减少 计划外再入院。尽管身体活动的好处众所周知，但人们并不经常鼓励身体活动， 老年住院患者 80% 以上的急症护理时间都在床上度过。增加体力的挑战 患有 ADRD 的老年患者的活动包括环境和政策问题（例如，缺乏进入地区的机会） 走）;护士缺乏如何评估、预防和管理谵妄和 BPSD 的知识； 系绳使用不当；患者、家属和护士相信卧床休息有助于康复 防止跌倒；患者缺乏起床的动力/意愿。增加体力活动和 预防住院期间的功能衰退，我们开发了针对急性护理的功能聚焦护理 (FFC-AC- EIT）适用于 ADRD 患者。 FFC-AC-EIT 的实施改变了护士提供护理的方式 在所有护理互动过程中，教导、提示和帮助 ADRD 患者进行身体活动。 FFC-AC-EIT 使用社会生态模型、社会认知理论和证据整合三角开发。 它涉及四步方法，包括： (1) 环境和政策评估； (2) 教育； (3) 制定患者目标； (4) 指导和激励员工、患者和家属。目的 本研究旨在随机测试 FFC-AC-EIT 在马里兰州和宾夕法尼亚州 12 家医院的疗效 FFC-AC-EIT 或仅限功能重点护理教育 (EO)，每家医院招募 50 名患者（总计 样本 600 名患者）。目标 1 将重点关注主要基于体力活动的患者层面的疗效， 功能，以及参与以功能为中心的护理，其次是谵妄、BPSD、疼痛、跌倒、使用 系绳和停留时间；以及所有这些结果（除了停留时间和系绳）以及紧急情况 出院后 1、6 和 12 个月的查房、再住院和新的长期护理入院；和 在单位层面，目的是评估 FFC-AC-EIT 对政策和环境的影响，以促进 实施后 6、12 和 18 个月的功能和身体活动。医院随机分配至 FFC-AC- EIT 将与随机分配至功能重点护理教育 (EO) 的患者进行比较。目标2将 根据治疗保真度（交付、接收、实施）136 以及相对成本和费用来评估可行性 FFC-AC-EIT 与 EO 相比节省。调查结果将涉及几个优先研究领域： ADRD；改善身体机能；对医院工作人员进行培训，并将证明该方法的有效性 护理 ADRD 患者，可以在所有急症护理机构中传播和实施。