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(ADRD)的老年人约占25% 住院的老年人。这些人患功能衰退、精神错乱、跌倒的风险增加， 与痴呆症相关的行为症状(BPSD)和较长的住院时间。运动期间的体力活动 住院(例如，活动、洗澡、穿衣)对老年人有积极影响，包括预防 功能衰退、疼痛减轻、神志不清、BPSD减少、跌倒减少、住院时间缩短和减少 计划外的再次入院治疗。尽管已知有好处，但人们并不经常鼓励体力活动，而且 老年住院患者80%以上的急性护理时间都在床上。增加物理容量所面临的挑战 老年ADRD患者的活动包括环境和政策问题(例如，无法进入 步行)；护士缺乏如何评估、预防和管理精神错乱和BPSD的知识； 不适当地使用系绳；患者、家属和护士认为卧床休息有助于康复和 防止摔倒；以及患者缺乏下床的动力/意愿。增加体力活动和 在住院期间防止功能下降我们开发了针对急性护理的功能集中护理(FFC-AC- EIT)用于ADRD患者。FFC-AC-EIT的实施改变了护士提供护理的方式 在所有护理互动中，教导、提示和帮助ADRD患者进行体力活动。FFC-AC-EIT 运用了社会生态模型、社会认知理论和证据整合三角理论。 它包括四个步骤，包括：(1)环境和政策评估；(2)教育；(3) 确立患者目标；以及(4)指导和激励工作人员、患者和家属。目的 这项研究是在马里兰州和宾夕法尼亚州的12家医院内随机测试FFC-AC-EIT的疗效 到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将重点放在主要基于体力活动的患者层面的疗效， 功能，参与功能集中的护理，其次是精神错乱，BPSD，疼痛，跌倒，使用 系绳、住院时间；以及所有这些结果(除了住院时间和系绳)以及紧急情况 出院后1、6和12个月的探视、再次住院和新的长期护理入院；以及 在单位一级，目的是评估FFC-AC-EIT对促进 在实施后6个月、12个月和18个月进行功能和体力活动。医院被随机分配到FFC-AC- EIT将与那些随机分为仅限功能集中护理教育(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以及相对成本和成本来评估可行性 FFC-AC-EIT与EO的节约。研究结果将涉及几个优先研究领域：重点是 ADRD；改善身体机能；培训医院工作人员，并将展示一种方法的有效性 护理ADRD患者，可在所有急性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.