PROGRAM HEAL--Activating the Lives of Older Adults

我们打算实施并测试综合干预措施的有效性，以预防养老院居民的功能障碍。干预措施通过促进锻炼采用和坚持以及扭转导致居民不活动的体制性因素来采取行动。我们的项目Hear(帮助老年人激活他们的生活)代表了两种干预措施的整合，这两种干预措施独立于我们研究所内不同的理论模型。一种选定的运动成分，基于渐进式阻力训练，促进疗养院居民的行为改变，已被证明在建立肌肉群、改善基于性能的身体功能测试、改善和防止日常生活能力下降方面是安全和有效的。以普遍护理为基础的康复部分针对导致居民不活动问题的社会和环境因素。我们已经表明，通过培训和鼓励将护理计划重新定向到每个居民的功能能力，可以通过针对设施内护理人员和社会力量的行为来帮助居民更多地参与日常活动。这些干预措施中的每一项在单独实施时都被证明在预防功能性残疾方面是有效的。作为康复干预模式，该计划促进了从锻炼计划中获得的功能能力收益在养老院居民的日常活动中的连续性。利用三个配套设施的现有工作人员，干预将在准试验性试验的范围内实施，涉及来自随机分配的仅进行试验性锻炼、试验性锻炼和基于护理的康复以及普通护理控制院的约1350名居民。功能状态的表现，以及生理、情绪和自我效能的测量将在基线和干预的4、8、12和16个月收集。这项拟议研究的目的是确定这种干预在现实世界环境中的有效性。具体地说，我们假设干预将在1)促进居民锻炼行为，2)改善生理测试的表现，以及3)远距离作用，以防止进一步的功能下降和促进功能改善。此外，我们预计对情绪、幸福感、自我效能感和生活质量结果有显著的影响。

We intend to implement and test the effectiveness of a comprehensive intervention to prevent functional disability among nursing home residents. The intervention acts by promoting exercise adoption and adherence and reversing institutional factors that cause resident inactivity. Our program, HEAL ('Helping Elders Activate their Lives'), represents an integration of two interventions developed independently from different theoretical models within our institute. A selected exercise component, based on progressive resistance training, promotes behavioral change among nursing home residents, and has been shown to be safe and efficacious in building muscle mass, improving performance-based tests of physical functioning, improving and preventing decline in activities of daily living. The universal nursing-based rehabilitation component targets social and environmental factors contributing to the problem of resident inactivity. We have shown that residents can be helped to be more self-involved in performance of daily activities by targeting behavior of nursing staff and social forces within the facility through training and encouraging a redirection of care planning towards each resident's functional capacity. Each of these interventions has been shown to be efficacious in preventing functional disability when implemented independently. Combined as the HEAL intervention model, the program facilitates the continuity of functional capacity gains resulting from the exercise program into the daily activity of nursing home residents. Making use of existing staffing at three triplets of matched facilities, the intervention will be implemented within the confines of a quasi-experimental trial, involving an estimated 1,350 residents from both randomly assigned experimental exercise only, experimental exercise and nursing based rehabilitation, and usual care control homes. Performance on functional status, and physiologic, mood and self-efficacy measures will be collected at baseline and months 4, 8, 12 and 16 of the intervention. The aim of the proposed study is to establish the effectiveness of this intervention acting in a real world setting. Specifically, we hypothesize that the intervention will act proximally in 1) promoting resident exercise behavior, 2) improve performance on physiologic tests, and 3) act distally to prevent further functional decline and facilitate functional improvement. Further, we anticipate significant carry over effects on mood, well-being, self-efficacy and quality of life outcomes.