Optimizing the mobility of residents with dementia: a pilot study promoting healthcare aide uptake of a simple mobility innovation in diverse nursing home settings

Abstract

BackgroundAlmost 90 percent of nursing home residents have some type of mobility limitation. Many spend most of their waking hours lying in bed or sitting. Such inactivity can negatively affect residents’ health and general well-being. This pilot study aimed to assess (1) the effect of the sit-to-stand activity on mobility outcomes of nursing home residents, (2) the effect of an audit-and-feedback intervention on uptake of the sit-to-stand activity by healthcare aides, and (3) the contextual factors influencing uptake of the sit-to-stand activity by healthcare aides.MethodsThis quasi-experimental pilot study was conducted in two nursing homes in western Canada. Twenty-six residents with dementia completed the sit-to-stand activity with 56 healthcare aides during daily care; separately, 71 healthcare aides completed a research use and context survey. Preliminary mobility feedback was presented to healthcare aides in one site. Resident mobility was measured using the 30-second sit-to-stand test. Healthcare aide uptake of the activity was measured using documentation flowsheets and a survey-based measure. Context was measured using the Alberta Context Tool. Mobility and uptake outcomes were analyzed over time and by site with analysis of covariance. Spearman and Pearson correlations were used to correlate context data with research use.ResultsResidents who more frequently completed the sit-to-stand activity were more likely to maintain or improve mobility compared with those who completed it less frequently (F=4.46; p=0.046, after adjustment for age). Uptake for one site was significantly different from the other (t-score=2.67; p=0.01, after adjustment for resident covariates). The audit-and-feedback intervention was associated with increased uptake of the activity from pre-intervention to post-intervention (t-score=-2.48; p=0.02). More context domains correlated significantly with aides’ use of conceptual research and information sources in one site than the other.ConclusionsThe sit-to-stand activity is a promising means to maintain or improve transfer ability of nursing home residents with dementia. In the nursing home with initially weak uptake, strengthened uptake followed an audit-and-feedback intervention. Activity participation was higher in the site with stronger correlations between context and measured research use. Results are sufficiently promising to warrant proceeding with a full clinical trial.

Making the Most of Mealtimes (M3): protocol of a multi-centre cross-sectional study of food intake and its determinants in older adults living in long term care homes

“…Not all eligible residents were contacted by the researchers; if they reached the 20 patient quota per home, the remaining list of eligible participants who had agreed to be approached by researchers was not exhausted. As resident participation rates for Canadian LTC research ranges from 65–72% [83–85], M3 had a successful participation rate which is attributed to the relationship building, training of home and research staff, as well as the non-invasive protocol. Participants were representative of the units where they lived.…”

The role of unregulated care providers in Canada—A scoping review

“…Results showed that simple interventions such as this could be integrated into the daily work routines of UCPs to slow decline in mobility and function in ADLs for residents with dementia (Slaughter et al., ). Other studies have explored the UCP role in diabetes management (Vincent et al., ), health promotion (Johnson & Noel, ), therapeutic recreational programmes (Sullivan & Sharpe, ), physical mobility (Slaughter & Estabrooks, ) and palliative care (Kaasalainen, Brazil, & Kelley, ). Table categorises tasks into the categories of (i) ADL & IADL tasks; (ii) housekeeping tasks; (iii) complex tasks delegated by regulated professionals; (iv) observation and documentation of clinical measures; and (v) additional tasks that promote independence and quality of life.…”

“…instrumental support (e.g., buy supplies in advance) provided by family caregivers lead to a positive work experience -Creating additional workload (e.g., tasks not about the patient) and lack of respect for the work done by home support workers lead to a negative work experience 54. Slaughter & Estabrooks. (2013) Experimental study Residential long-term-care -Sit-to-stand activity helped residents with dementia maintain mobility and slowed functional decline…”

“…Case study Residential long-term-care -Lack of collaboration between personal support workers (PSWs) and social workers or other members of the team -PSWs may require more education and training to gain cultural competency which has potential to improve quality of care (Johnson & Noel, 2007) and providing emotional support to patients (Berta et al, 2013;Giosa, Holyoke, Bender, Tudge, & Gifford, 2015;Kortes-Miller et al, 2015;Waskiewich, Funk, & Stajduhar, 2012). According to Guay et al (2013) (Vincent et al, 2016), health promotion (Johnson & Noel, 2007), therapeutic recreational programmes (Sullivan & Sharpe, 2005), physical mobility (Slaughter & Estabrooks, 2013) and palliative care (Kaasalainen, Brazil, & Kelley, 2014). Table 3…”

Prevalence of mobility disabilities in nursing home residents and the association with age, BMI, fall risk and social participation

“…While 18.5% (n = 381) of the participants were completely independent of mobilisation assistance from others, 23.0% were almost independent, 19.2% partly dependent, 15.5% nearly dependent, and 23.8% completely dependent, a total of 81.5% (n = 1,673). Thus, qualitative statements such as "the majority of nursing home residents have a mobility disability" [8] could be quantified, and the estimate of Slaughter et al [47] that 90% of the residents have mobility disabilities can now be specified. The current study also quantifies the high demand for support for nursing home residents, which is usually provided by other people and in RCFs, mainly by caregivers.…”