The goal of this 3 year study is to devise and test a model ADL intervention, using graduated prompts and social reinforcement, to achieve and maintain functional independence in nursing home residents with Alzheimer's dementia (DAT). The proposal involves the intensive study of one prototype ADL, dressing. It includes an assessment of dressing based on real-time observations of task performance; a determination of excess disability; and, an individually designed and administered dressing training program involving the least amount of caregiver assistance needed to dress. A unique aspect of the study is the use of microcomputer technology for real-time recording of dressing performance; this enables examination of the reciprocal relationship between a resident's dressing behaviors and a caregiver's assistive actions. Subjects will be a maximum of 72 nursing home residents with DAT and dressing disability. Direct observations of dressing will take place under 3 caregiving conditions: 1) naturalistic, that is, with the nursing assistant helping the resident to dress; 2) minimally prompted, that is, with an occupational therapist allowing the resident to dress as independently as possible and giving only the help needed; 3) ADL intervention, that is, with the occupational therapist providing graduated prompts for dressing, withdrawing prompts gradually as independence is increased, and, giving social reinforcement for increased independence in dressing. The amount of dressing disability remaining at the conclusion of the intervention will be viewed as 'actual"""""""" disability. Estimates of excess ADL disability will be obtained by comparing actual disability with the disability exhibited under naturalistic and minimally prompted caregiving conditions. An exploratory aspect of the study involves the examination of subject characteristics (e.g., cognitive status, depression) with the intent of identifying residents who respond most favorably to the ADL intervention. The anticipated yield of the study is an ADL intervention that can be transferred to indigenous nursing home staff for implementation in their normal work routines and tested in a large scale clinical trial. Results of the study will also increase our understanding of excess ADL disability and of caregiving actions that maximize functional independence, reduce aberrant resident behaviors during ADL, and improve caregiver/resident interactions during care routines.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
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Special Emphasis Panel (SRC (03))
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University of Pittsburgh
Schools of Medicine
United States
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Rogers, J C; Holm, M B; Burgio, L D et al. (2000) Excess disability during morning care in nursing home residents with dementia. Int Psychogeriatr 12:267-82
Rogers, J C; Holm, M B; Burgio, L D et al. (1999) Improving morning care routines of nursing home residents with dementia. J Am Geriatr Soc 47:1049-57
Holm, M B; Rogers, J C; Burgio, L D et al. (1999) Observational data collection using computer and manual methods: which informs best? Top Health Inf Manage 19:15-25