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

基本信息

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
项目类别：
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&apos s Disease Alzheimer&apos 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

项目摘要

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.

患有阿尔茨海默氏病和相关痴呆症（ADRD）的老年人约占25％住院的老年人。与痴呆症（BPSD）相关的行为症状和较长的住院时间住院（例如移动性，沐浴，敷料）对老年人有积极影响，包括预防功能下降，减轻疼痛，减少del妄，bpsd，跌倒较少，停留时间较短和减少植入的hosspital再入院，尽管已知好处老年医院的患者花费超过80％的挑战。 ADRD老年患者的活动包括环境和政策问题（例如，无法进入地区步行）；在护士中缺乏有关如何评估，预防和管理BPSD的知识；在患者，家庭和护士中，床休息的不当使用有助于康复防止跌倒；预防功能下降的同时，同时我们开发了急性护理功能的关注护理（FFC-AC-- EIT）用于ADRD的患者。在所有护理护理互动中，教，提示和帮助ADRD患者进行身体活动是使用社会生态模型，社会认知理论和证据整合三角发展开发的。它涉及一个四步的方法，包括：（1）环境和政策评估；（2）教育；建立患者的目标；这项研究是为了测试FFC-AC-EIT在马里兰州和宾夕法尼亚州随机的12家医院中的功效仅由50名患者招募，只有50名患者样本600例AIM 1。功能和参与专注的护理，以及del妄，bpsd，痛苦，跌倒，使用老师和住宿时间；出院后1、6和12个月，房间探访，重新住院和新的新长期护理入院；在单位级别，目的是评估FFC-AC-EIT对促进政策和环境的影响植入后6、12和18个月的功能和体育活动。 EIT将与仅随机与融合护理教育的人进行比较（EO）根据治疗保真度（交货，收到，颁布）136评估可行性，相对成本和成本 FFC-AC-EIT与EO的储蓄将解决严格的研究领域：重点 ADRD；护理可以在所有急性护理机构中传播和实施的ADRD患者。