A pressure injury (PrI) can develop when repositioning/movement (hereafter, movement) is inadequate; the PrI prevention cornerstone is self or nurse assisted movement to facilitate the ?15-minutes of decompression required to reperfuse tissues. Half of nursing home (NH) residents have Alzheimer?s Disease and Other Dementias (hereafter, dementia) and 75% are likely to develop a PrI; PrIs are up to 18% higher in obese NH residents (25%). Both groups spend lengthy periods in bed or chair because of often limited ability to move and participate in own care, thus increasing tissue compression. Research is needed to identify movement patterns that effectively maintain skin integrity among 4 NH resident subgroups (dementia/obese; dementia/non-obese; no dementia/obese; no dementia/non-obese). Responding to program announcement NOT-AG-18-039, this proposed study will examine NH resident movement data collected via accelerometer in the parent study 1R01NR016001 ?Turn Everyone And Move for Ulcer Prevention? cluster randomized controlled trial being conducted over a 4-week intervention period in each of 9 NHs. Further, nursing staff?s approaches to obesity- related and dementia-related (Behavioral and Psychological Symptoms of Dementia (BPSD)) behaviors will be examined to explain previously unstudied interactions and differences in movement features and patterns and to create movement pattern indices, thus aiding our long-term goal to create a tailored dementia PrI prevention protocol to improve movement. The proposed descriptive exploratory study will use a mixed-methods approach with quantitative and qualitative analyses of movement patterns (self or assisted).
The specific aims are:
Aim 1 determine up to 10 most frequent patterns of 3 movement features: average daily movement frequency, body position frequency, and position durations that exist in our NH populations (secondary quantitative data analyses?9NHs), Aim 2 determine differences in resident characteristics (age, gender, race/ethnicity, average Braden total and subscale score(s), movement features, and most frequent movement patterns (Aim 1), as well as their interactions within each of the 4 subgroups. (secondary quantitative data analyses?9NHs), Aim 3 determine those resident characteristics (age, gender, race/ethnicity, average Braden total and subscale score(s), obesity yes/no, dementia yes/no), movement features, repositioning compliance, frequency and duration of decompression episodes, and their interactions that predict movement patterns for NH residents (secondary quantitative data analyses?9NHs), and Aim 4 explore resident obesity-related behaviors, resident dementia-related behaviors (BPSD), and nursing approaches observed during repositioning events that are associated with different movement patterns (primary qualitative focus group data; quantitative observational data?3 NHs). This study will advance knowledge of dementia and obesity effects on repositioning, lead to improved resident repositioning protocols, and enable tailoring and testing of PrI prevention interventions for more effective PrI prevention and at earlier stages of dementia.
Alzheimer?s disease and related dementias increase with age and our aging population is notably heavier than previous generations of those in nursing homes; dementia and obesity contribute to reduced movement putting residents at risk of developing a pressure injury (also known as bed sore). The goal of this research is to improve on the current ?one size fits all? approach to pressure injury prevention by identifying how dementia and obesity affect the resident?s immobility, movement patterns, and repositioning. This knowledge will make it possible to tailor and test resident focused pressure injury prevention interventions and help dementia residents adopt repositioning behaviors that are effective in reducing pressure injury development.
| Yap, Tracey L; Kennerly, Susan M; Horn, Susan D et al. (2018) TEAM-UP for quality: a cluster randomized controlled trial protocol focused on preventing pressure ulcers through repositioning frequency and precipitating factors. BMC Geriatr 18:54 |
