Abstract
BackgroundHospitalized older persons with Alzheimer’s disease and related dementias are at greater risk for functional decline and increased care dependency after discharge due to a combination of intrinsic factors, environmental, policy, and care practices that restrict physical and cognitive activity, lack of family involvement and limited staff knowledge of dementia care. We have developed a theory-based intervention, Family centered Function-focused Care, that incorporates an educational empowerment model for family caregivers (FCGs) provided within a social-ecological framework to promote specialized care to patients with dementia during hospitalization and the 60-day post-acute period. Primary aims are to test the efficacy of the intervention in improving physical and cognitive recovery in hospitalized persons living with Alzheimer’s disease and related dementias (ADRD) and improving FCG preparedness and experiences.MethodWe will implement Family centered Function-focused Care in a cluster-randomized trial of 438 patient/FCG dyads in six hospital units randomized within three hospitals. We hypothesize that patients who receive the intervention will demonstrate better physical function, less delirium occurrence and severity, neuropsychiatric symptoms, and depression compared to those in the control condition (Education-only). We also hypothesize that FCGs enrolled in Family centered Function-focused Care will experience increased preparedness for caregiving, and less strain, burden, and desire to institutionalize, as compared to FCGs the control group. We will also examine the costs and relative cost savings associated with the intervention and will evaluate the cultural appropriateness of Family centered Function-focused Care for families from diverse backgrounds.DiscussionOur theory-based intervention makes use of real-world applicable approaches in a novel and innovative way to change the paradigm of how we currently look at acute care and post-acute transitions in persons with ADRD.Trial registrationClinicalTrials.gov, ID: NCT03046121. Registered on 8 February 2017.
Highlights
Hospitalized older persons with Alzheimer’s disease and related dementias are at greater risk for functional decline and increased care dependency after discharge due to a combination of intrinsic factors, environmental, policy, and care practices that restrict physical and cognitive activity, lack of family involvement and limited staff knowledge of dementia care
Our theory-based intervention makes use of real-world applicable approaches in a novel and innovative way to change the paradigm of how we currently look at acute care and post-acute transitions in persons with ADRD
That patients with ADRD receive the type of care, beginning at admission and continuing through the post-acute transitional period, that optimizes cognitive and physical function and physical activity and helps prevent or decrease functional decline.We have developed a theory-based intervention that adapts Function Focused Care (FFC) to the hospitalized person with dementia
Summary
The care and services provided in the hospital have a profound and permanent effect on persons with ADRD and their families, in terms of their inpatient experience, and their ongoing functioning, relationships, wellbeing, quality of life and the fundamental decisions that are made about their future. The negative consequences of an acute illness or injury often begin prior to the hospitalization [115] and persist well into the post-acute period, resulting in increased risk for care dependency, FCG burden, long-term nursing home stay, resource consumption, and cost. The proposed study builds upon pilot work [54, 55] in the acute care setting and focuses on improving functional and behavioral outcomes that impact the quality of life for both FCGs and patients with dementia, a population that is often excluded from acute care research. The study findings will be relevant for other areas of behavior-change research in acute care, those related to engaging patients and families in health care planning, delivery, and evaluation (Additional file 1).
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