The population of older adults residing in Assisted Living (AL) facilities is expected to grow over the next decade to 2 million (Mollica &Johnson-Lemarche, 2005). Older adults who reside in AL experience progressive cognitive decline and self-care disability that necessitate the more costly and intensive care of a nursing home (NH) within an average of 1-3 years (Golant, 2004). The model of everyday competence describes how cognitive skills are linked to older adults'problem solving and self-care competency for activities of daily living (ADLs) necessary to remain in AL. Protective effects of cognitive training on problem solving and self-care performance have been empirically verified for cognitively-intact, community-dwelling elders (Willis et al., 2006). Thus, research is needed to determine whether cognitive training will improve cognition and self- care for AL residents who suffer from mild cognitive impairments. This study will test the effects of cognitive training on AL residents'everyday problem solving, self-care, and NH home placement. This study will test a new cognitive intervention, Reasoning Exercises in Assisted Living (REAL), designed specifically for AL residents. The intervention was modeled after the inductive reasoning skills found to improve cognition and maintain self-care over 5 years in healthy, independent older adults (Willis et al., 2006). REAL teaches reasoning and applied problem solving skills to empower AL residents to solve problems essential to maintain self-care that will delay NH placement (Willis, 1991, 1996). REAL successfully improved problem solving scores of AL residents in a preliminary study (Williams, 2008). Problem solving performance and self-care measures will be collected before and after the intervention with follow-ups at 3 and 6 months. Linear mixed modeling will be used to compare the REAL experimental group, a placebo VITAMIN education group, and a no treatment CONTROL group on everyday problem solving and self-care performance. Length of AL residency and NH placement will be compared between groups after 6 months. Secondary resident and facility factors that influence problem solving and self-care will be tested as covariates. Cost-effectiveness analysis will evaluate costs of providing REAL in ratio to improved self-care. This study tests a cognitive training intervention for AL residents with mild cognitive impairments, an expanding population of frail elders who are at risk for cognitive decline and self-care disability prompting NH placement. This study targets National Institute of Nursing Research (NINR) goals of promoting health through translation of behavioral interventions to clinical settings to benefit older adults and the Healthy People 2010 goals of increasing years of healthy life. The long-term goal is provide cognitive training to increase resident length of stay in AL and to identify other factors (e.g. depression) that can be modified to delay NH placement and reduce costs of care for older adults.
This study tests a cognitive training intervention for residents of Assisted Living facilities, a rapidly expanding population of frail elders who experience progressive cognitive and self-care decline that contributes to nursing home placement. This study targets National Institute of Nursing Research (NINR) goals of promoting health through translation of behavioral interventions to clinical settings to benefit older adults and the Healthy People 2010 goals of increasing years of healthy life. The long-term goal is to provide targeted cognitive training to promote self-care and ultimately to delay NH placement from AL, which could reduce health care costs for frail elders by over 50% per year.
| Williams, Kristine; Herman, Ruth; Bontempo, Daniel (2014) Reasoning Exercises in Assisted Living: a cluster randomized trial to improve reasoning and everyday problem solving. Clin Interv Aging 9:981-96 |
| Williams, Kristine; Herman, Ruth; Smith, Erin Kate (2014) Cognitive interventions for older adults: does approach matter? Geriatr Nurs 35:194-8 |
