Two-thirds of older adults with dementia, compared with 27 percent of their cognitively intact counterparts, are substantially limited in their ability to carry out activities of daily living (ADLs) such as dressing, eating, and bathing. A few approaches can help nursing home residents with dementia participate in care that helps restore their functioning (restorative care) and quality of life, suggests a new study.
The researchers used focus groups with seven geriatric nursing assistants (NAs), who were experts in dementia care, to explore facilitators and barriers to engaging these residents in functional activities and exercise. The NAs suggested getting to know a person's past and former role in life to understand what "makes them tick." For example, telling a former journalist he had a press conference to go to would motivate him to get up and get dressed. Use of humor and play, which sometimes makes residents feel like they are around their family, also encourages them to participate in restorative care.
Many of the NAs considered teamwork with fellow NAs, other nursing staff, rehabilitative staff, and medical providers and families a key component of engaging impaired residents in restorative care activities. For example, they would contact medical providers if they saw any change of status, which could be due to depression or a urinary tract infection and could inhibit participation in restorative care.
Other helpful approaches were use of short, verbal cues and repetition to provide clear direction during ADLs, and use of assistive devices, favorite foods, and flexible scheduling. They cited barriers to restorative care such as resident anxiety and agitation (which sometimes made tasks difficult or staff fearful), overly sedating medication, lower family expectations, and communication breakdown among the staff. The study was supported in part by the Agency for Healthcare Research and Quality (HS13372).
See "'Knowing what makes them tick': Motivating cognitively impaired older adults to participate in restorative care," by Elizabeth M. Galik, Ph.D., C.R.N.P., Barbara Resnick, Ph.D., C.R.N.P., F.A.A.N., F.A.A.N.P., and Ingrid Pretzer-Aboff, Ph.D., R.N., in the International Journal of Nursing Practice 15, pp. 48-55, 2009.
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