Activities Of Daily Living Support Research Articles

Rural-urban and regional variations in aspects of caregiving, support services and caregiver health in the USA: evidence from a national survey

ObjectivesDue to substantial regional variability in available caregiving services and supports, culture and health status among informal caregivers in the USA, the study objective was to explore how rural-urban differences...

Effect of an educational intervention on nurses’ competence in activities of daily living support in end-of-life care using a pretest–posttest repeated measures design

BackgroundMost patients in specialized palliative care units need nursing support to perform activities of daily living (ADL), such as using a toilet or transferring out of a bed or chair. To deliver high-quality ADL support that facilitates patients’ movement and protects nurses’ musculoskeletal health, nurses need appropriate knowledge and skills. The objective of this study is to investigate the impact of education based on the “Advanced Kinaesthetics in Palliative care (AdKinPal) program” on the competence in Kinaesthetics, self-efficacy regarding ADL support in end-of-life care and musculoskeletal complaints of nurses from specialist palliative care units.MethodsA pretest–posttest repeated measures design was applied. The study took place in three specialised units for palliative care in Switzerland between June 2018 and April 2020. All the nurses who worked in participating wards (n = 62) and fulfilled the inclusion criteria were asked to participate. The intervention – the AdKinPal program – is an education-based training program conducted for six months. We took measurements using self-administered questionnaires at three points before and after the intervention. Using descriptive statistics, repeated measurement analysis of variance (ANOVA) and independent-samples t-tests, we analysed the participants’ demographic characteristics as well as developments over time and relationships between the three outcome variables: Kinaesthetics competence, self-efficacy regarding ADL support in end-of-life care and musculoskeletal complaints.ResultsFifty-nine nurses and one physiotherapist participated, and 38 participants (63%) responded to all three questionnaires. The AdKinPal training improved the nurses’ perceived Kinaesthetics competence and self-efficacy regarding ADL support in end-of-life care. Participants who reported lower back, neck or shoulder pain had a significantly lower Kinaesthetics competence.ConclusionsThe AdKinPal program can raise nurses’ Kinaesthetics competence. Thereby, patients’ autonomy and quality of life could be supported, and symptom management could be enhanced in a holistic manner. Furthermore, the AdKinPal program fosters nurses’ self-efficacy in ADL support in end-of-life care. A strong sense of self-efficacy enhances professional well-being in many ways. Additionally, the nursing staff’s musculoskeletal health can be promoted by enhancing their Kinaesthetics competence.Trial registrationDRKS00015908. Registration Date 23.11.2018.

Association between inpatient clinical nursing acuity and 30-day rehospitalization among hospitalized patients with advanced cancer.

1544 Background: Half of patients with advanced cancer experience multiple hospital readmissions, which are burdensome to patients and their family members. During hospitalization, nurses provide assistance with medication administration, activities of daily living (ADLs), and other care needs. However, it is not known how nursing support required during hospitalization may relate to hospital readmissions. Using data from a post-discharge supportive care trial, we analyzed the association between nursing acuity on day of discharge to home and 30-day rehospitalization among patients with advanced cancer. Methods: The data for this exploratory analysis came from a single-arm pilot trial (n=54) of a nurse practitioner-led supportive care telehealth intervention at Massachusetts General Hospital (MGH). We enrolled English-speaking adults with advanced breast, gastrointestinal, genitourinary, or thoracic cancers who had an unplanned hospitalization and were being discharged home without hospice. MGH uses the Harris Healthcare AcuityPlus workload and productivity system to measure patients’ need for nursing care twice daily, in order to define nurse staffing levels. AcuityPlus groups patients into six levels of acuity (1=0-5 hours; 2=5-7 hours; 3=7-10 hours; 4=10-14 hours; 5=14-20 hours; 6=20+ hours). We conducted chart reviews to determine 30-day hospital readmission rates and analyzed the last AcuityPlus assessment before hospital discharge. We described rates of 30-day hospital readmissions by nursing acuity level. Results: From 01/07/21 to 05/28/21, we enrolled 54 patients (median age=65.0 years; 59.3% and 22.2% had advanced gastrointestinal or thoracic cancers, respectively). On day of discharge, no patients were classified as acuity level 1, while 25.9% of patients were classified as acuity level 2. 53.7% were in acuity level 3 and 20.4% were in acuity levels 4-6. Further, at discharge, 64.8% of patients received partial or extended assistance with ADLs, and 53.7% were assessed at least every 2 hours. At 30 days, 10 (18.5%) patients were readmitted to the hospital, all of whom were in acuity category 3 or higher on the day of discharge. No patients in acuity level 2 were readmitted. Conclusions: In this cohort of hospitalized patients with advanced cancer enrolled in a post-discharge supportive care study, overall need for nursing care, ADL support, and assessment was high, with over 70% of patients receiving at least 7 hours of nursing care on the day of discharge. While some nursing care received was influenced by inpatient nursing protocols, all readmitted patients had high nursing needs at discharge. These results support further study in larger cohorts of the relationship between inpatient nursing needs and likelihood of readmission in hospitalized patients with advanced cancer to improve support at home for recently hospitalized patients. Clinical trial information: NCT04640714 .

Determinants associated with medical-related long-term care service use among community-dwelling older adults in Taiwan

IntroductionMedical-related long-term care (LTC) service use among community-dwelling older adults in Taiwan is resource-intensive, and planning is essential to promote aging-in-place. MethodsAdministrative data from 4/1/2017 to 11/26/2019 among more than 14,000 residents were analyzed with generalized estimating equations (GEEs) to identify determinants of medical-related LTC service use. ResultsOlder adults using medical-related LTC services tended to be younger (79.9 vs. 80.7; p<.0001), male (42.7% vs. 38.5%; p<.0001), multi-morbid (3.1 vs. 2.5; p<.0001), and higher mean activities of daily living (ADL) disability (8.2 vs. 4.2; p<.0001), instrumental ADL (IADL) disability (11.0 vs. 9.1; p<.0001), and hospitalizations (1.1 vs. 0.4; p<.0001). Significant determinants of medical-related LTC services include age, education, stroke, coronary heart disease, diabetes, vision impairment, ADL disability, and prior hospitalization. DiscussionThe success of LTC 2.0 will depend on ADL support and care coordination to manage chronic conditions such as diabetes, vision impairment, coronary heart disease, and stroke.

The easy ADL home: A physical-virtual approach to domestic living

Smart environments worthy of the name need to capture, interpret, and support human activities that take place within their realms. Most existing efforts tend to focus on either real world activities or activities taking place in the virtual world accessed through digital devices. However, as digital computation continues to permeate our everyday real world environments, and as the border between physical and digital continues to blur for the human agents acting in these environments, we need system design approaches that can cope with human activities that span the physical-virtual gap. In this paper, we present such an approach and use it for designing a smart home intended to support Activities of Daily Living (ADL). The easy ADL home is designed based on a wearable personal server that runs a personal ADL support middleware and a set of computationally augmented everyday objects within the easy ADL home. An initial qualitative study of the system involving 20 subjects revealed a highly positive attitude (score 4.37 out of 5) towards the system's capability of co-locating and synchronizing physical and virtual events throughout the everyday activity scenarios, while classical usability aspects in particular related to the gesture-based input (score 2.89 out of 5) leaves room for improvement.

Parent caregiving choices of middle-generation Blacks and Whites in the United States.

This study compares how middle-generation caregivers and non-caregivers differ by race and explores racial differences in activities of daily living (ADL), instrumental activities of daily living (IADL), and financial assistance that middle-generation caregivers provide for their parents. Using 2000 Health and Retirement Study data, racially stratified descriptive analyses and logistic regression models for ADL, IADL, and financial assistance are presented. Parental need and race influence support, with similar patterns of Black and White ADL support, but racial differences in IADL and financial support. Having more children motivates Whites to increase IADL support and reduce financial support; more children decreases Blacks' IADL support. Sibling caregiver networks influence IADL and financial support in ways that vary by race. The number employed is a key determinant for Blacks for all support, but only influences White ADL support. The findings of this article indicate the importance of sample stratification by race and that employment or other subsidies may aid the expansion of caregiving by middle-generation adults.

IMPACT OF A RESTORATIVE CARE PROGRAM IN THE NURSING HOME

The purpose of this study was to determine the impact of a progressive mobility restorative program on nursing home residents' ability to perform selected activities of daily living (ADLs) and the amount of staff assistance needed to help residents complete these ADLs. A one group repeated measures design study was conducted in a 255-bed university affiliated geriatrics center. A certified nursing assistant (CNA) specially trained in restorative mobility techniques worked with residents individually for at least 15 minutes per day, five days per week to achieve their individualized mobility goals. Items on ADL Self-Performance and ADL Support Provided from the Minimum Data Set (MDS) were collected at baseline, three months, and six months. Thirty-eight of 42 residents (90%) were included in the analyses and 31 residents (82%) completed at least 25 days of restorative activities. Some residents improved their ADL self-performance at three and six months (15% and 33%, respectively) and decreased in the amount of ADL support provided at three and six months (26% and 31%, respectively). Total ADL self-performance and support provided did not change significantly over the six-month period. Most residents maintained their baseline ADL self-performance and level of ADL support provided over the six-month study. A progressive mobility restorative program implemented by a certified nursing assistant specially trained in restorative techniques resulted in most residents maintaining their baseline ADL self-performance abilities and the level of assistance provided by staff. Studies are needed to determine if these types of programs can actually improve functional abilities and decrease the level of staff assistance needed to complete ADLs or if they are effective in maintaining or delaying functional loss and staff burden.