Patricia Heacock

Improving Dressing Behavior in Cognitively Impaired Nursing Home Residents

This study tested the extent to which a behavioral intervention, Strategies to Promote Independence in Dressing (SPID), improved dressing independence among 90 cognitively impaired nursing home residents (average score on Mini Mental Status Exam = 7.35 +/- .69). The effect of SPID on caregiving efficiency, the time required for nursing assistants to use the strategies, was also examined. The results showed improved independence (decrease in assistance) from 6.08 +/- .12 at baseline to 4.93 +/- .19 following 6 intervention weeks. This significant improvement in dressing independence occurred without a clinically relevant increase in caregiver time (less than 1 min). Seventy-five percent of the subjects improved one or more levels of dressing independence, and more than 20% achieved their maximum intervention effect during the first week of treatment.

Assisting cognitively impaired elders with activities of daily living

As the population ages, cognitive impairment will affect larger numbers of older Americans. Decreased ability to perform activities of daily living is related to cognitive impairment. However, the extent to which activity of daily living (ADL) dependence is related to actual physical and cognitive impairment or is environmentally induced has yet to be established. A variety of strategies may help to increase the ADL ability of cognitively impaired (CI) older adults. Each older person has an individual pattern of cognitive deficits, therefore, a decision-making process for selection of the appropriate strategies must be used. Nurses often have the opportunity to help improve the quality of life of and interactions between the CI and their caregivers. The “prescribing” of strategies for use when performing ADL activities represents one method to improve the lives and care of CI persons. We encourage caregivers to use the decision-making process to identify appropriate strategies in their interactions with CI older adults regardless of the living situation. These concepts work equally well in acute-care hospitals, private home, or nursing homes. Through their use, maximal independencefor CI older adults is encouraged.

Sustaining a best-care practice in a nursing home.

&NA; This study tested whether an action research organizational intervention fostering participatory management practices would sustain a nursing best‐care practice protocol in a nursing home. An experimental nursing home (EH) and a control nursing home (CH) with similar characteristics were studied over a 4‐year period. A pretest/posttest quasi‐experimental design was used. Baseline data were collected on residents, families, and the staffs at the EH and the CH. Staff turnover rates, demographics of participant groups, and surveys concerning job stress, nursing care, family involvement, and satisfaction of residents and family members served as proximal outcomes to indicate whether organizational changes had occurred in the EH. Sustaining best practices in a nursing home requires not only significant organizational change but also changes in regulatory support for quality care, sufficient staff resources to implement and monitor the practices, and a change coordinator with sufficient formal or informal influence.

Dressing for Success: Promoting Independence Among Cognitively Impaired Elderly

In demented persons, activities of daily living skills may deteriorate more quickly than their cognitive decline warrants because caregivers do not allow them to perform ADLs to the full extent of their abilities. Caregiver actions that promote independent behaviors were used with subjects in home and nursing home settings. Four of five home subjects showed decreased caregiver assistance and increased ability to dress more independently. Although nursing home subjects did not show a decrease in caregiver assistance, observation showed that some nursing home caregivers did incorporate behavioral strategies, suggesting potential clinical efficacy of the strategies.

Cognitively Impaired Elders USING RESEARCH FINDINGS TO IMPROVE NURSING CARE

1. Cognitive changes may be similar in people with Alzheimers disease, but each person loses abilities differently, and each individual responds differently to interventions. 2. Assessment of cognitive function is needed in order to design appropriate interventions that will be specific in facilitating independence in cognitively impaired elders. 3. Research findings suggest that functional ability in cognitively impaired elders can be maximized by assessing cognitive abilities and using this information to tailor specific interventions that will facilitate independence.

Caring for the Cognitively Impaired: Reconceptualizing Disability and Rehabilitation

Rehabilitative interventions must be based on remaining cognitive and physical abilities while recognizing the presence of disabilities. Rehabilitation goals should be to provide the least restrictive environment using the least restrictive intervention, thus promoting independence. The use of behavioral strategies that support remaining abilities and compensate for cognitive deficits is recommended as a rehabilitative approach. The behavioral approach requires an assessment of the ADL steps, the range of activities a person is able to complete, and the kinds of caregiver assistance needed.

Assessing dressing ability in dementia

Cognitive impairment can profoundly affect the skills required for activities of daily living (ADL). Most cognitive screening measures assess cognitive status rather than the cognitive functions that underlie ADL tasks. The dressing assessment guide (DAG) assesses the cognitive and functional abilities in dressing of patients with dementia. The DAG evaluates everyday and overlearned tasks and uses cues to provide a context for action. Nurses can easily administer the guide, and the resulting data provide the basis for nursing interventions.