Function and Behavior Focused Care for Nursing Home Residents with Dementia

描述（由申请人提供）：护理中度至重度认知障碍的养老院居民传统上遵循监护方法，护理人员专注于最大限度地减少行为问题，并在护理活动中为这些人执行必要的功能任务。虽然是无意的，但在监护实践中更有可能发生对护理的抵抗、功能下降、不动的医疗并发症、过度使用精神药物和不良事件，如福尔斯。因此，它是至关重要的，以实现非药物干预，以尽量减少行为障碍，优化身体功能，并降低不良事件的风险与中度至重度认知impairement.To应对这些挑战，拟议的研究将测试功能和行为为重点护理认知受损（FBFC-CI）干预的有效性。FBFC-CI基于社会生态学模型，旨在通过激励和教授护理人员技能来改变护理人员的行为，以减少痴呆症疗养院居民的行为症状，优化功能和身体活动。本研究的目的是测试FBFC-CI对中度至重度认知障碍居民的行为和功能结果的影响，并探讨在设施层面采取干预措施。具体来说，我们将实施FBFC-CI在12个养老院（40个居民每个养老院）的480名居民的集群随机试验，以实现以下目标：目标1。评价FBFC-CI对居民行为症状（抑郁、护理抵抗、激越）、精神药物使用、功能（ADL、表现）和体力活动（调查、活动记录）的有效性;目的2.评价FBFC-CI对不良事件（福尔斯、急诊室入院和住院）的影响;目标3。演示员工采用和维护FBFC方法的使用。住院医生将有中度至重度认知障碍（MMSE d 15），并将在基线、4个月和12个月时收集数据。这项研究将是一个关键的下一步，在描绘如何改变护理方法提供给居民中度至重度痴呆症，以减少行为症状，优化功能和体力活动，并减少不适当的精神药物的使用和不良事件经历这些人。

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.