Preventing Decline in Older Adults Through Function-Focused Care
After moving to assisted living (AL) facilities, many older adults exhibit a decline in their overall functioning, which is associated with increased risks of depression and diminished quality of life. A variety of factors contribute to functional decline in elders, including reduced physical activity. Although not all of these factors are remediable, a systematic effort to enhance residents’ functioning and encourage physical activity can help them improve and maintain function, according to a promising study published in the November issue of the Journal of the American Geriatrics Society (https://bit.ly/JAGS-FFC-AL).
The study, led by Barbara Resnick, PhD, CRNP, Sonya Ziporkin Gershowitz Chair in Gerontology, University of Maryland School of Nursing, and president, American Geriatrics Society (AGS), evaluates the efficacy of an approach to care known as function-focused care (FFC). Specifically, it evaluates FFC-Assisted Living (FFC-AL), a form of FFC tailored to the abilities and needs of residents in AL facilities. This approach to care was developed by Resnick and colleagues.
In many AL facilities, the “culture of care… is to meet residents’ needs through task completion (eg, to bathe or dress the individual) rather than to optimize underlying physical capability,” Resnick and coauthors explain. As a result, there is a tendency for facilities’ direct-care workers (DCWs) to perform tasks, such as bathing and feeding, even when residents are able to fully or partially handle these tasks themselves. This level of assistance increases the likelihood that residents’ abilities to manage these activities of daily living will diminish over time. “Thus, in the residents’ best interest, the philosophy of care...should change to one that evaluates residents’ underlying capacity, helps them achieve and maintain their highest functional level, and increases their time spent in physical activity.”
Because DCWs provide most of the care in AL facilities, the primary goal of FFC-AL is to change the way DCWs provide care. Rather than carry out tasks for residents, DCWs are taught to provide residents with only as much help as required, and to encourage and help them to be more physically active.
Resnick and colleagues evaluated FFC-AL in four AL facilities over a 12-month period. Their study included 171 residents and 96 DCWs. The DCWs and the residents were randomly assigned to either the intervention or the “attention control” group. A Function-Focused Care Nurse (FFCN; a specially trained registered nurse) worked with the DCWs in the intervention group and with a licensed practical nurse (LPN), who was designated to be the “staff champion” and charged with both assisting with the intervention and ensuring that the protocol was followed after the study ended. Before launching the intervention, the FFCN identified and addressed barriers to the FFC-AL approach for residents in the intervention group. Barriers included a lack of safe areas where residents could walk and a need for chairs and beds of appropriate height to allow residents to get up and move around on their own. All DCWs in the intervention group attended an educational session during which they learned how to engage residents and incorporate FFC-AL into the care they provided. The FFCN worked with each resident, the DCW caring for him or her, and the LPN to set goals tailored to each resident’s abilities (eg, getting dressed or attending an on-site exercise class). The FFCN and LPN together offered advice and encouragement throughout the 12 months. DCWs in the “attention control” group were simply invited to an educational session about FFC-AL.
At the end of the 12 months, residents in the intervention group exhibited significantly less decline in function than controls, Resnick and colleagues report. In addition, the number of intervention-group residents who transitioned from relying on wheelchairs to ambulating increased over the course of the year. “This change from a sedentary wheelchair-dependent status to ambulating at least short functional distances has important implications for prevention of complications of immobility such as infections and contractures,” the researchers noted. Residents in the intervention group also increased the amount of physical activity they had, without suffering additional adverse effects (eg, falls or injuries).
These findings suggest that “FFC-AL may help to prevent the functional decline and sedentary behavior commonly noted in [AL] settings,” the researchers conclude. “From a clinical perspective, nurses and others working in AL communities should feel confident that implementing FFC-AL will benefit residents and will not put them at risk of injuries and falls.” Resnick and colleagues note the importance of additional studies and follow-up. The AGS looks forward to learning more about this encouraging intervention.
