Current trends in long-term care, in concert with CMS Quality of Life guidelines, call for a shift in focus to "person-centered care". Evolving conceptualizations of optimal care in the nursing home (NH) are emphasize the need to "know the person" in order to deliver individualized, holistic care. However, incorporating the elder's perspective as a central component in shaping care delivery depends on having a comprehensive and reliable instrument that can gather this information effectively. Currently, no such assessment instrument is available. Knowledge of a resident's everyday life preferences is the foundation on which ongoing individualized care planning is based. Despite this centrality, the reliability of preferences for care has not been assessed in a NH sample. The purpose of this study is to develop a comprehensive, assessment instrument that incorporates NH residents'views of what preference items are most important to them, assess the reliability of preference responses over time, and to examine predictors of changes in resident preferences. In Phase 1 (n=80), this study will use cognitive interviewing techniques to adapt the Preference for Everyday Living Inventory (PELI), originally designed for community dwelling elders, to ensure its applicability to frail residents in NHs, including those with mild to moderate cognitive impairment. In addition, Phase 1 will test the one week reliability of the instrument and cull unreliable items. Using this newly adapted instrument, Phase 2 (n=300) will address which preferences are most and least important to residents and the reliability of preferences over a three month period for NH residents. Multivariate and logistic regression, as well as structural equations models will be used to examine relationships between reliability in preference responses and hypothesized predictor variables suggested from preliminary studies by this research team and the literature. Focus group participants (n=40) will enable us to examine sources of changes in preference responses from the resident's perspective. We will also examine exploratory hypotheses related to examine concordance between family proxy and resident preference responses. The completion of the proposed project will lead to the submission of an R01 proposal testing the PELI embedded in an intervention program designed to ameliorate behavioral and affective disturbances in persons with dementia residing in NHs. The primary specific aims are: 1) Adapt PELI to frail elders residing in NHs using cognitive interviewing (CI) techniques;examine one week test-retest reliability;and cull unreliable items;2) Identify the most and least significant areas of everyday preferences from the perspective of NH residents, both with and without cognitive impairment;3) Quantitatively assess the reliability of preference responses of NH residents over a 3-month period and test hypothesized relationships between predictors and resident changes in preference responses;and 4) Qualitatively examine response reliability issues from residents'perspective. Exploratory aim: Examine the concordance between resident-rated preferences and family member proxy ratings of resident preferences.
This primary goal of this study is to redesign and test the reliability of a measure of psychosocial preferences for everyday living in a frail nursing home population. Measurement development and reliability determination are necessary first steps in the ultimate goal of using this measure to enhance holistic individualized care to nursing home residents.
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