Testing the Impact of FFC‐AL‐EIT on Psychosocial and Behavioral Outcomes in Assisted Living

Abstract

BACKGROUND This study tested the impact of Function Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC‐AL‐EIT) on: (1) care interactions between residents and direct care staff; and (2) behavior and psychological symptoms associated with dementia among residents. DESIGN This was a randomized controlled trial. SETTING A total of 59 assisted living facilities in Maryland, Pennsylvania, and Massachusetts participated. PARTICIPANTS The sample included 550 mostly White (98%), female (69%) residents with a mean age of 89.30 (standard deviation = 7.63) years. INTERVENTION The four‐step FFC‐AL‐EIT intervention was implemented by a function focused care nurse facilitator working with a facility champion over 12 months. The steps included: (1) environment and policy assessments; (2) education; (3) establishing resident function focused care service plans; and (4) mentoring and motivating. MEASURES Resident descriptive data (e.g., age, sex, education, and comorbidities), depression, agitation, resistiveness to care, and the quality of care interactions were obtained at baseline and 4 and 12 months. Treatment fidelity data included environment and policy assessments, performance of function focused care by staff, and service plan assessments. RESULTS There was a significant positive treatment effect related to depression, agitation, resistiveness to care, and quality of care interactions with either less decline or some improvement in these behaviors and symptoms in the treatment versus control group. CONCLUSION The study provides some statistical support, which may not necessarily be clinically significant evidence, for psychosocial outcomes of residents and care interactions between staff and residents in assisted living settings.

Enrichment of dementia caregiving relationships through psychosocial interventions: A scoping review

“…Regardless of whether the interventions aimed to stimulate positive social interactions ( 59 – 61 , 66 ) or empowerment ( 56 , 87 ), the fact that the focus was on the social aspects themselves and not on regular caregiving duties ( 63 , 68 , 75 ) provided structure to the social interactions. Socially oriented caregiving: Some interventions ( n = 6) described a shift from “passive” caregiving responsibilities to a more socially oriented approach ( 82 ) of enabling meaningful relationships to form between care staff and PLWD ( 63 , 68 ), encouraging openness in the dyadic relationship ( 84 ) and engaging PLWD in social interactions in the caregiving routine ( 75 , 82 ).…”

“…However, few included studies reported on interventions delivered in institutional settings adapting an activity or environment to support PLWD's participation in valued activities. Some examples were identified, such as creating a more responsive dining environment for dyadic interaction (88), story-telling groups (73), or educating staff to adapt and optimize interactions in caregiving (68,82,89). With research indicating that nursing home residents with dementia are involved in few social activities (99)(100)(101)(102), there is a need for more interventions to support "fine tuning" in formal caregiving to facilitate shared social activities that might enrich the caregiving dyad.…”

“…The second category encompassed ten interventions covering carer training either as a single-component intervention (64,(80)(81)(82)(83) or using educational modules as one of the multicomponent interventions (63,(84)(85)(86)(87). Interventions focusing solely on carer education and training included modules to promote integrity for PLWD (80), enhancing family visits to nursing homes (64), dyadic communication training (81,83) and training to support PLWD's functional abilities (82). Where education and training were part of multicomponent interventions, they focused on re-ablement (84,85), empowerment (87), cognitive behavioral therapy (CBT) (86), and palliative care (63).…”

Racial Disparities in Care Interactions and Clinical Outcomes in Black Versus White Nursing Home Residents With Dementia

“…It is not clear, however, if function was optimized by engaging these individuals in bathing, dressing, and encouraging ambulation versus using a more task-focused approach and making sure that care tasks were provided (eg, that the resident was bathed and dressed). Although caregivers are concerned that encouraging function may exacerbate behavioral symptoms in this population, findings actually support the opposite 39. Interventions should continue to implement approaches to care that help optimize function in all individuals with moderate to severe dementia.…”

Developing a toolkit to improve resident and family engagement in the safety of assisted living: Engage—A stakeholder‐engaged research protocol

“…As the population ages, AL use is expected to grow (Sengupta et al, 2015). The goal of AL is to provide residential long‐term care for residents to age in place and to be as independent as possible for as long as possible, making it a unique setting distinct from the hospital or nursing home (Resnick et al, 2021). Consistent with the goal of promoting independence, leaders in AL research and practice have prioritized providing person‐centered care, including a focus on personhood, autonomy, and relationship‐based care practices (Zimmerman, Cohen, et al, 2014, Zimmerman, Allen, et al, 2015).…”