Improving morning care routines of nursing home residents with dementia

OBJECTIVES: This study examined the effectiveness of a behavioral rehabilit ation intervention for improving the performance of morning care activities of daily living (ADL) of nursing home residents with dementia. DESIGN: Participants and their caregivers were observed for 5 days each und er conditions of Usual Care (naturalistic) and Skill Elicitation (intervent ion), and for 15 days under Habit Training (intervention follow-up). Observ ations involved the ADL categories of DRESSING, OTHER ADL, and NO ADL. A 3 x 3 design (condition X ADL category) was used. SETTING: Observations occurred in five proprietary nursing homes in Pittsbu rgh, Pennsylvania. PARTICIPANTS: The participants were 58 women and 26 men, mean age 82 years (range = 64 - 97, SD = 6.3), with Probable Alzheimer's disease (AD) (n = 19 ) and Possible AD (n = 65), with a mean MMSE score of 6.07. INTERVENTION: Condition 1, Usual Care, was the naturalistic caregiving cond ition. Condition 2, Skill Elicitation, consisted of an individualized behav ioral rehabilitation intervention designed to identify and elicit retained ADL skills. Under Condition 3, Habit Training, the behavioral rehabilitatio n intervention was continued to reinforce and solidify retained skills and to facilitate further functional gains. MEASUREMENTS: A computer-assisted data collection system was used to docume nt in real-time the assists used by caregivers, the participants' ADL perfo rmance, and the participants' responses to caregiving, including disruptive behavior. RESULTS: Compared with Usual Care, during Skill Elicitation part icipants increased the proportion of time engaged in nonassisted and assist ed dressing significantly and increased their overall participation in ADL, with a concomitant significant decrease in disruptive behavior. These func tional gains were demonstrated within 5 days of initiating the behavioral r ehabilitation intervention and were maintained for 3 weeks during Habit Tra ining. Physical assists were provided for significantly smaller proportions of a morning care session during Skill Elicitation and Habit Training comp ared with Usual Care. CONCLUSIONS: Even very severely cognitively impaired and functionally disab led nursing home residents can respond to a systematically implemented beha vioral rehabilitation intervention. Their rapid response to this interventi on suggests that it is alleviating excess disabilities brought on by care p atterns rather than retraining ADL task performance. Residents with dementi a benefit from behavioral rehabilitation by becoming more appropriately inv olved in their care and being less disruptive. However, behavioral rehabili tative care takes considerably more time than usual care.