Abstract
Objectives
The purpose of this study was to evaluate the Function-Focused Care for Assisted Living
Using the Evidence Integration Triangle (FFC-AL-EIT) intervention.
Design
FFC-AL-EIT was a randomized controlled pragmatic trial including 85 sites and 794
residents.
Intervention
FFC-AL-EIT was implemented by a Research Nurse Facilitator working with a facility
champion and stakeholder team for 12 months to increase function and physical activity
among residents. FFC-AL-EIT included (Step I) Environment and Policy Assessments;
(Step II) Education; (Step III) Establishing Resident Function-Focused Care Service
Plans; and (Step IV) Mentoring and Motivating.
Setting and Participants
The age of participants was 89.48 years [standard deviation (SD) = 7.43], and the
majority were female (n = 561; 71%) and white (n = 771; 97%).
Methods
Resident measures, obtained at baseline, 4, and 12 months, included function, physical
activity, and performance of function-focused care. Setting outcomes, obtained at
baseline and 12 months, included environment and policy assessments and service plans.
Results
Reach was based on 85 of 90 sites that volunteered (94%) participating. Effectiveness
was based on less decline in function (P < .001), more function-focused care (P = .012) and better environment (P = .032) and policy (P = .003) support for function-focused care in treatment sites. Adoption was supported
with 10.00 (SD = 2.00) monthly meetings held, 77% of settings engaged in study activities
as or more than expected, and direct care workers providing function-focused care
(63% to 68% at 4 months and 90% at 12 months). The intervention was implemented as
intended, and education was received based on a mean knowledge test score of 88% correct.
Evidence of maintenance from 12 to 18 months was noted in treatment site environments
(P = .35) and policies continuing to support function-focused care (P = .28)].
Conclusions and Implications
The Evidence Integration Triangle is an effective implementation approach for assisted
living. Future work should continue to consider innovative approaches for measuring
RE-AIM outcomes.
Keywords
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References
- Perceptions and performance of function and physical activity in AL communities.J Am Med Dir Assoc. 2010; 11: 406-414
- Physical activity and functional fitness in institutionalized vs. independently living elderly: A comparison of 70–80-year-old city-dwellers.Arch Gerontol Geriatr. 2011; 53: e10-e16
- Understanding nursing home worker conceptualizations about good care.Gerontologist. 2013; 53: 246-254
- Impact of care settings on residents' functional and psychosocial status, physical activity and adverse events.Int J Older People Nurs. 2015; 10: 273-283
- The impact of function focused care and physical activity on falls in assisted living residents.Can J Nurs Res. 2020; 52: 45-53
- Factors influencing the physical activity of older adults in long term care: Administrators perspectives.J Aging Phys Act. 2009; 17: 181-195
- Knowledge, attitudes and intentions about participation in physical activity of older post acute hospital inpatients.Physiotherapy. 2009; 95: 192-198
- Resnick B. Galik E. Boltz M. Pretzer-Aboff I. Implementing Restorative Care Nursing in All Setting. 2nd ed. Springer, New York, NY2011
- A dedicated approach to restorative nursing.J Gerontol Nurs. 2009; 35: 37-44
- The effectiveness of function-focused care interventions in nursing homes: A systematic review.J Nurs Res. 2020; 27: 1-13
- Pilot testing of the restorative care intervention for the cognitively impaired.J Am Med Dir Assoc. 2008; 9: 516-522
- Effects of an abilities focused program of morning care residents who have dementia and on caregivers.J Am Geriatr Soc. 2000; 48: 442-449
- Deprescribing as a clinical improvement focus.J Am Med Dir Assoc. 2020; 21: 355-360
- Translation of function focused care to assisted living facilities.Fam Community Health. 2014; 37: 101-165
- Ecological foundations of health promotion.Am J Health Promot. 1996; 10: 270-281
- Self-efficacy: The Exercise of Control.W.H. Freeman, New York, NY1997
- An evidence integration traingle for aligning science with poliy and practice.Am J Prev Med. 2012; 42: 646-654
- The international endorsement of US distress screening and psychosocial guidelines in oncology: A model for dissemination.J Natl Compr Cancer Netw. 2014; 12: 221-227
- Mental illness training on the internet for nurse aides: A replication study.J Psychiatr Ment Health Nurs. 2013; 20: 902-912
- Predicting control beliefs in older adults: A micro-longitudinal study.J Gerontol B Psychol Sci Soc Sci. 2020; 75: e1-e12
- Testing the impact of function focused care in assisted living.J Am Geriatr Soc. 2011; 59: 2233-2240
- Psychometric testing of the function focused environment assessment and the function focused policy assessment in assisted living.J Housing Elderly. 2019; 33: 153-172
- Reliability and validity of the Checklist for Function Focused Care in Service Plans.Clin Nurs Res. 2020; 29: 21-30
- The Mini-Cog as a screen for dementia: Validation in a population-based sample.J Am Geriatr Soc. 2003; 51: 1451-1454
- Cumulative illness rating scale.J Am Geriatr Soc. 1968; 16: 622-626
- Functional evaluation: The Barthel Index.Mad State Med J. 1965; 14: 61-66
- Restorative care nursing activities: Pilot testing self efficacy and outcome expectation measures.Geriatr Nurs. 2003; 24: 83-87
- Testing of the Res-Care pilot intervention: Impact on nursing assistants.Geriatr Nurs. 2004; 25: 292-297
- Reliability and validity of knowledge and self-efficacy and outcome expectation for restorative care activities measures.J Nurs Care Q. 2008; 23: 162-169
- Health Education Planning: A Diagnostic Approach.1st ed. Mayfield, Mountain View, CA1980
- Diffusion of Innovations.5th ed. Free Press, New York, NY2003
- Diffusion of innovations in service organizations: Systematic review of recommendations.Milbank Q. 2004; 82: 581-629
- Implementation science in the real world: A streamlined model.J Healthcare Q. 2012; 34: 27-36
- Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science.Implement Sci. 2009; 4: 50
- Outcomes for implementaiton research: Conceptual distinctions, measurement challenges, and research agenda.Admin Policy Ment Health. 2011; 38: 65-76
- Exploring path models of disablement in residential care and assisted living residents.J Appl Gerontol. 2018; 37: 1490-1516
- Factors that influence physical activity among residents in assisted living.J Housing Elderly. 2017; 60: 120-137
- Variation in volumes and characteristics of trauma patients admitted to a level one trauma centre during national level 4 lockdown for COVID-19 in New Zealand.N Z Med J. 2020; 133: 81-88
- Factors associated with changes in perceived quality of life among elderly recipients of long-term services and supports.J Am Med Dir Assoc. 2016; 17: 44-52
- Nutrition, obesity, and exercise association of light physical activity measured by accelerometry and incidence of coronary heart disease and cardiovascular disease in older women.J Am Med Assoc Netw Open. 2019; 2: 1-14
- Measuring physical activity in older adults: Calibrating cut-points for the MotionWatch 8((c)).Front Aging Neurosci. 2015; 7: 165
- Calibration of the computer science and applications, Inc. accelerometer.Med Sci Sports Exerc. 1998; 30: 777-781
- Physical activity in the United States measured by accelerometer.Med Sci Sports Exerc. 2008; 40: 181-188
- Accelerometer assessment of physical activity and its association with physical function in older adults residing at assisted care facilities.J Nutr Health Aging. 2016; 20: 752-756
- Reliability and validity testing of the MotionWatch 8 in older adults.J Nurs Meas. 2017; 25: 7-11
- MotionWatch 8 Overview.(Available at:)https://www.camntech.com/products/motionwatch/motionwatch-8-overviewDate accessed: August , 2020
- Time to reduce agitation in persons with dementia in nursing homes. A process evaluation of a complex intervention.BMC Health Serv Res. 2019; 19: 1-9
- Adoption, reach, and implementation of a cancer education intervention in African American churches.Implement Sci. 2017; 12: 1-11
- National dissemination of StrongWomen-Healthy Hearts: A community-based program to reduce risk of cardiovascular disease among midlife and older women.Am J Public Health. 2015; 105: 2578-2585
- Resident-centered job satisfaction and turnover intent among direct care workers in assisted living: A mixed-methods study.Res Aging. 2012; 34: 337-364
- The impact of enhanced programming on aging in place for people with dementia in assisted living.Am J Alzheimers Dis Other Dement. 2015; 30: 733-737
- Residents Living in Residential Care Facilities: United States, 2010 National Center for Health Statistics Data Brief No. 91, pp1-6.National Center for Health Statistics, Hyattsville, MD2012
Article info
Publication history
Published online: October 29, 2020
Footnotes
Funding: This work was supported by the National Institutes of Health, National Institute on Aging (Grant R01AG050516).
Identification
Copyright
© 2020 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
