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

• 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
• 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' s Disease; Alzheimer' 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

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.

老年人患有阿尔茨海默氏病和相关痴呆症（ADRD）的老年人约25％ 住院的老年人。这些人有功能下降，ir妄，跌倒，跌倒的风险增加 与痴呆症（BPSD）相关的行为症状和更长的住院时间。体育锻炼期间 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，较少的ir妄，bpsd少，跌倒较少，停留时间较短和改善 计划外的医院再入院。尽管有已知的益处，但并不是通常鼓励体育锻炼 老年住院的患者将超过80％的急性护理住在床上。增加身体的挑战 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 走）;护士之间缺乏有关如何评估，预防和管理del妄和BPSD的知识； 不适当使用系数；相信患者，家庭和护士之间的床休息有助于康复和 防止跌倒；患者缺乏动力/愿意起床。增加体育锻炼和 预防功能下降，同时我们开发了急性护理功能的关注护理（FFC-AC-- EIT）适用于ADRD患者。 FFC-AC-EIT的实施改变了由护士提供护理的方式 在所有护理互动期间，教授和帮助ADRD患者进行体育锻炼。 FFC-AC-EIT 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。 它涉及一种四步方法，其中包括：（1）环境和政策评估； （2）教育； （3） 建立患者目标； （4）指导和激励员工，患者和家庭。目的 这项研究是为了测试马里兰州和宾夕法尼亚州的12家医院内FFC-AC-EIT的效率 仅招募50名患者（总计） 样本600名患者）。 AIM 1将主要基于体育锻炼，专注于患者水平的效率， 功能和参与功能专注的护理，以及del妄，BPSD，疼痛，跌倒，使用 系tethers和住宿时间；以及所有这些结果（除外的住院时间和tethers）以及紧急情况 出院后1、6和12个月，房间访问，重新院发生和新的长期护理入院；和 在单位级别，目的是评估FFC-AC-EIT对促进政策和环境的影响 实施后6、12和18个月的功能和体育活动。随机分配给FFC-AC-的医院 将EIT与仅随机以功能为中心的护理教育（EO）进行比较。 AIM 2意志 根据治疗保真度（交付，收据，颁布）136评估可行性，相对成本和成本 FFC-AC-EIT与EO的节省。调查结果将解决一些优先研究领域：关注 adrd;改善身体功能；和医院工作人员的培训，并将证明一种方法的效率 护理可以在所有急性护理机构中传播和实施的ADRD患者。