Developing Rehabilitative Behavioral Interventions for Long‐Term Care: Technology Transfer, Acceptance, and Maintenance Issues

Abstract

Rehabilitative behavioral interventions that are documented in clinical trials to improve nursing home resident outcomes and are recommended by practice guidelines are often not adapted for daily use in nursing homes and other long-term care (LTC) facilities. Failure to evaluate issues other than clinical efficacy when developing interventions contributes to this gap between efficacy and effectiveness in practice. A potential solution is a research model that supplements traditional clinical intervention research with methodology designed specifically to evaluate the ability of LTC facilities to implement the interventions. This paper discusses several critical issues of intervention and implementation that should be addressed, including targeting interventions, advocacy, cost-effectiveness, training, and quality control. We also describe how clinical trials could be designed and staged to increase the probability that effective interventions will be implemented in the day-to-day care of frail older patients in LTC facilities.

Developing recommendations for implementing the Australian Pain Society's pain management strategies in residential aged care

“…In part, a lack of collaboration between clinicians and guideline developers can result in a lack of interest in, and understanding of, revised practice [11]. Guidelines may also not be adopted in clinical practice because of resource or feasibility issues [12,13]. Involving stakeholders in the development and implementation process is likely to be useful in increasing the uptake of practice guidelines [14] and in ensuring that guidelines are feasible and practical in clinical settings.…”

Mobility of Vulnerable Elders (MOVE): study protocol to evaluate the implementation and outcomes of a mobility intervention in long-term care facilities

“…Approximately 60% of the loss of ability to walk in residents with dementia is potentially treatable [4]. The effectiveness of rehabilitation to facilitate mobility has been studied in LTC settings with dedicated research assistants or extensively trained staff caregivers [19-30]; however, the evidence that such rehabilitative approaches will be transferred, accepted, or sustained in the typically resource constrained environments of contemporary residential LTC facilities is lacking [31-33]. Few investigators have examined the effectiveness of techniques to encourage mobility by the usual caregivers in these settings, that is, by the unregulated health care aide workforce.…”

Pain Assessment Practices With Nursing Home Residents

“…Two studies found that, in the absence of adequate staffing, caregivers often cut corners in care delivery (Bowers & Becker, 1992;Riggs & Rantz, 2001). The constrained fiscal resources in nursing homes and the regulated environment may also prevent optimal practice patterns (Aday & Andersen, 1974;Schnelle, Cruise, Rahman, & Ouslander, 1998) while encouraging a rigid, static environment with high staff turnover, poor communication patterns, and difficult nurse recruitment (Caudill, & Patrick, 1989;Chopoorian, 1986;Cohen-Mansfield, 1997;Walker, Porter, Grunman, & Michalski, 1998).…”