Function-Focused Goal Attainment and Discharge Outcomes in Hospitalized Persons With Dementia

Abstract

Hospitalized persons with dementia are at higher risk for functional decline and cognitive loss related to delirium. Family-centered, function-focused care (Fam-FFC) engages the family care partner in education and active participation in function-focused goal setting, implementation, and evaluation to support delirium prevention and abatement and return to baseline physical function. The purpose of the current study was to examine the association of function-focused goal attainment with two discharge outcomes, return to baseline physical function and delirium severity at discharge, in hospitalized persons with dementia. In the ongoing Fam-FFC clinical trial, the majority of goals ( N = 433) developed by 134 care partner/patient dyads and nurses address mobility, cognitive stimulation, and self-care. Regression techniques demonstrated that goal attainment was significantly associated with return to baseline function ( B = 0.826, Wald = 4.17 [1], p = 0.041) and lower delirium severity at discharge ( B = 0.175, t = 2.239, p = 0.027). Results support the contribution of family engagement in promoting functional recovery of hospitalized persons with dementia. [ Journal of Gerontological Nursing, 47 (9), 13–20.]

Transforming the discharge conversation through support and structure: A scoping review

“…Many of the studies emphasized interpersonal communication emblematic of support that enabled caregiver activation and preparedness. Features of interpersonal communication included, sitting with the caregiver during the review of discharge paperwork ( Agarwal et al, 2020 ; Bauer et al, 2011 ; Bloomer et al, 2016 ; Boltz et al, 2021 ; Çelik and Bilik, 2020 ; Cesta, 2014 ; Chenoweth et al, 2021 ; Fitzgerald et al, 2011 ; Gwernan-Jones et al, 2020 ; Jamieson et al, 2016 ; Kelley et al, 2019 ; Mockford, 2015 ; Mockford et al, 2016 ; Prusaczyk et al, 2019 ; Sagbakken et al, 2020 ; Sawan et al, 2021 ; Stockwell-Smith et al, 2017 ; Whittamore et al, 2014 ), encouraging caregivers to ask questions and relay information ( Boltz et al, 2021 ; Jamieson et al, 2016 ; Mockford, 2015 ; Mockford et al, 2016 ; Sawan et al, 2021 ), check-in with caregiver to confirm readiness and comfort with role and accompanying responsibilities ( Çelik and Bilik, 2020 ; Kelley et al, 2019 ; Ownsworth et al, 2020 ), offering tangible informational resources according to the needs of both patient and caregiver ( Bauer et al, 2011 ; Cesta, 2014 ; Chenoweth et al, 2021 ; Fitzgerald et al, 2011 ; Sagbakken et al, 2020 ; Whittamore et al, 2014 ), and extending words of encouragement, including acknowledgement of their role as caregiver and a respected member of the care team ( Cesta, 2014 ; Gwernan-Jones et al, 2020 ; Jamieson et al, 2016 ).…”

“…Information exchange refers to the process of actively gathering information from and relaying information to caregivers with the goal of personalizing care to the specific needs of the caregiver and patient. Researchers have found multiple examples of communication techniques that promote information exchange ( Bauer et la., 2011 ; Boltz et al, 2021 ; Çelik and Bilik, 2020 ; Cesta, 2014 ; Jamieson et al, 2016 ; Kelley et al 2019 ; Mockford, 2015 ; Sagbakken et al, 2020 ). Mockford et al (2016) noted the importance of increasing medical staff knowledge of the role of the caregiver and incorporating caregiver consultations in patient care planning to be more inclusive of the caregiver role.…”

“…A complementary theme to Support is Structure, which reflected the system-level procedures and processes that could be modified to foster more supportive nurse communication with caregivers in discharge interactions while improving the nurse care experience. Examples of procedural changes included, providing caregivers with an informational packet and establishing a point of contact among the care team upon admission ( Agarwal et al, 2020 ; Bauer et al, 2011 ; Bloomer et al, 2016 ; Fitzgerald et al, 2011 ; Jamieson et al, 2016 ; Sawan et al, 2021 ; Whittamore et al, 2014 ), standardization of training protocols and goals of care conversations between nurse and caregiver—including a review of policies that may conflict with family involvement ( Boltz et al, 2021 ; Chenoweth et al, 2021 ; Kelley et al, 2019 ; Sagbakken et al, 2020 )—providing daily reports on patient status ( Fitzgerald et al, 2011 ), creating a discharge plan at admission and reviewing patient care needs with caregivers over the span of the admission period ( Fitzgerald et al, 2011 ; Gwernan-Jones et al, 2020 ; Mockford, 2015 ; Stockwell-Smith et al, 2017 ), and, when possible, assigning patients consistent care team members to ensure continuity of care and sharing patient information with patient's primary care provider ( Mockford et al, 2016 ; Prusaczyk et al, 2019 ).…”

“…Caregivers experienced various conflicts communicating with care team members and often felt overwhelmed and lost when making life and death decisions. Boltz et al 2021 United States Descriptive Analysis Dementia Examined the return to baseline physical function as well as delirium severity among individuals living with dementia following hospital function-focused goals conversation with caregivers at discharge. Persons with dementia demonstrated improved functional outcomes and experienced less delirium when function-focused goals were discussed with their caregivers at discharge.…”

An exploration of the cultural appropriateness of the family-centered function-focused care intervention

“…Although not typical practice in the acute care setting, discussions of patients' needs and preferences between nurses and the patient's close family members have been found to be useful in predicting and preventing excessive stress in persons with dementia, while lessening the anxiety of care partners. Further, family members can play a positive role by motivating and encouraging patients during the hospitalization and subsequently at home (Boltz et al, 2015b(Boltz et al, , 2021.…”