Doris L. Milke

Mobility of Vulnerable Elders Study: Effect of the Sit-to-Stand Activity on Mobility, Function, and Quality of Life

OBJECTIVES The aim of this study is to assess the effect of the sit-to-stand activity on the mobility, function, and health-related quality of life of nursing home residents with dementia. DESIGN A longitudinal quasi-experimental intervention study with intervention and control groups. SETTING The study was conducted in 7 nursing homes (4 intervention; 3 control) in Edmonton, Canada. PARTICIPANTS Eligible residents had a diagnosis of dementia and were able to transfer independently, or with the assistance of 1 person. INTERVENTION Health care aides prompted residents to repeat the sit-to-stand activity daily during care routines on day and evening shifts. MEASUREMENTS Mobility was measured using the 30-second sit-to-stand test and the time to complete one sit-to-stand. Function (Functional Independence Measure), health status (Health Utilities Index Mark 2 & 3) and disease-specific quality of life (Quality of Life-Alzheimers Disease instrument) were also measured. Outcome measures were collected at baseline, and at 3 and 6 months. The covariates cognition, depression, and medical instability were derived from the Resident Assessment Instrument Minimum Data Set (Version 2.0), and the facility context covariate was measured using the Alberta Context Tool. RESULTS A total of 111 residents completed the 6-month trial (56 intervention; 55 control). Residents in the intervention facilities maintained mobility, as measured by the time to complete one sit-to-stand (P = .01), and experienced a slower functional decline, as measured by the Functional Independence Measure (P = .01), from baseline to 6 months compared with residents in the control facilities, after adjusting for age, sex, cognition, depression, medical instability, and context. CONCLUSIONS Maintaining the ability to transfer using the sit-to-stand activity is a promising means of optimizing the mobility and function for residents with dementia in nursing homes.

Dignity and Distress towards the End of Life across Four Non-Cancer Populations

Objective The purpose of this study was to identify four non-cancer populations that might benefit from a palliative approach; and describe and compare the prevalence and patterns of dignity related distress across these diverse clinical populations. Design A prospective, multi-site approach was used. Setting Outpatient clinics, inpatient facilities or personal care homes, located in Winnipeg, Manitoba and Edmonton, Alberta, Canada. Participants Patients with advanced Amyotrophic Lateral Sclerosis (ALS), Chronic Obstructive Pulmonary Disease (COPD), End Stage Renal Disease (ESRD); and the institutionalized alert frail elderly. Main Outcome Measure In addition to standardized measures of physical, psychological and spiritual aspects of patient experience, the Patient Dignity Inventory (PDI). Results Between February 2009 and December 2012, 404 participants were recruited (ALS, 101; COPD, 100; ESRD, 101; and frail elderly, 102). Depending on group designation, 35% to 58% died within one year of taking part in the study. While moderate to severe loss of sense of dignity did not differ significantly across the four study populations (4–11%), the number of PDI items reported as problematic was significantly different i.e. ALS 6.2 (5.2), COPD 5.6 (5.9), frail elderly 3.0 (4.4) and ESRD 2.3 (3.9) [p < .0001]. Each of the study populations also revealed unique and distinct patterns of physical, psychological and existential distress. Conclusion People with ALS, COPD, ESRD and the frail elderly face unique challenges as they move towards the end of life. Knowing the intricacies of distress and how they differ across these groups broadens our understanding of end-of-life experience within non-cancer populations and how best to meet their palliative care needs.

Behavioral Mapping of Residents’ Activity in Five Residential Style Care Centers for Elderly Persons Diagnosed with Dementia: Small Differences in Sites Can Affect Behaviors

The principal purpose of the study was to investigate the day-long patterns of activity of residents and staff in five similar care centers for people with Alzheimers disease. The Therapeutic Environment Assessment Scale provided an architectural basis for assessing the significance of activity data gathered through behavior mapping. Slight architectural differences contributed to effects that were large and enduring, producing as much as a 50% differences between sites in the portion of residents involved. Taken together, the results suggest that resident status, use patterns, and architectural design details of a homelike residential setting have significant effects on the daily activities of residents.

Meeting the Needs in Continuing Care of Facility-Based Residents Diagnosed With Dementia: Comparison of Ratings by Families, Direct Care Staff, and Other Staff

Effective facility-based continuing care of persons diagnosed with dementia requires trust and cooperation between the professional caregivers and the families of the residents. Miscommunications may affect many aspects of staff-family relationships. The knowledge and expectations of these groups, however, are typically quite different. The purpose of this study was to compare families, direct caregivers, and other staff and volunteers on their perception of the degree to which residents’ needs were being met. Although these groups agreed that the majority of needs were being met adequately, the groups did differ. Specifically, compared to families and other staff and volunteers, the direct caregivers were more critical of bedside care, their own professional training, and the work of others. Families, in contrast, were more critical of their loved ones’ limited opportunities for freedom of choice. The findings have value for the care of persons with dementia residing in care facilities.

Eight Years of Data on Residents in Small Dementia-Care Settings Suggest Functional Performance Is Maintained

Eight years of data analysis on residents’ status from three small Alzheimer care centers suggest notable stability in function. Individuals’ functional ability was best in their first year, but their year-to-year decline was mostly not significant. Cognitive abilities also were best in the residents first year, but first-, second-, and third-year cognitive scores were not significantly different. We compared the residents’ dementia progression rate to the true rate of natural disease progression. This study, like others on small homelike settings, suggests that appropriate homelike environments maintain persons with dementia at an optimum level longer.