Promoting the "Good Life" among Nursing Home Residents with Alzheimer's Disease and Related Dementias: The Role of Special Care Units

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Project Summary/Abstract Many adults over age 65 with Alzheimer’s disease and related dementias (ADRD) reside in nursing homes (NHs) to receive advanced medical care and supervision as the diseases progress. Yet, numerous NHs are struggling with best practices in the delivery of care to residents with ADRD. NH Alzheimer’s special care units (ASCUs) are one potentially promising feature in some NHs related to better resident care and outcomes. However, we are yet to understand what is ‘special’ about these units and the characteristics and care practices associated with beneficial outcomes and improved quality of life. This Pathway to Independence proposal will contribute substantially to our understanding of how to ensure the “Good Life” among residents with ADRD in a novel, structured, and evidence-informed approach, establishing the candidate as an emerging leader in health services research committed to advancing research on care for persons with ADRD. The data obtained in Aim 1 of this proposal will provide critical first-hand experiences from residents with ADRD, their families, and nursing staff providers on quality of life and care practices among this population. These findings will be integrated into an evidence-informed “Good Life” model of NH care in Aim 2 and implemented and evaluated in Aim 3 in a small but rigorous randomized controlled clinical trial. These Aims are well-aligned with NIA priorities including challenges and burdens associated with caregiving, models of care in long-term supports and services, disparities in health care access, and promoting health in persons with ADRD. Collectively, knowledge gained in this proposal will inform a subsequent R01 application to conduct a more definitive examination of the “Good Life” model of NH care. Findings will also have implications for persons with ADRD and their families, NHs, policy makers, and researchers on how to promote the “Good Life” in long-term care communities. To promote this Pathway to Independence, the candidate has established commitment from an exceptional, highly accomplished mentorship team of leading experts in long-term care research, conducting pragmatic clinical trials in NHs, qualitative and quantitative methodology, and direct resident care. Importantly, these members have successful current and prior collaborations amongst themselves and with the candidate, one even serving on the candidate’s dissertation committee. In addition to the innovative research Aims, this proposal will pursue rigorous training and career development activities designed to complement and further the candidate’s skills in key research areas: qualitative methods, pragmatic clinical trial design, translational and implementation science, caregiver shadowing in NHs to observe direct resident care, grant writing, teaching, and scholarly presentations and publications. The University of Maryland, School of Social Work is pleased to support this proposal and all related activities for the candidate. This Pathway to Independence proposal is the natural and necessary next step to establish the candidate as an independent interdisciplinary health services researcher and leader committed to identifying, optimizing, and disseminating best care practices for persons living with ADRD.