Reabilitação respiratória no idoso pós-cirurgia ortopédica / Respiratory Rehabilitation in the Elderly after Orthopedic Surgery

Com a melhoria dos processos terapêuticos e socioeconómicos assiste-se a uma rápida transição demográfica, refletindo-se num aumento da esperança de vida, mas também num exponencial aumento de pessoas idosas com doenças crónicas e consequentemente em situação de dependência. Em Portugal, os indivíduos com mais de 65 anos representam cerca de 20% de toda a população, o que tem óbvias implicações na saúde respiratória. A elevada prevalência da patologia respiratória surge como uma das doenças crónicas mais influentes na dependência nos idosos. Para além disto, nos serviços de internamento hospitalar, a cirurgia ortopédica representa taxas de ocupação mais elevada nos indivíduos com mais de 65 anos. As cirurgias implicam restrição de mobilidade e desta advém a dependência e a dispneia nos autocuidados. A Reabilitação Respiratória é por isso crucial. O presente estudo tem como objetivo principal avaliar o efeito de um programa de reabilitação respiratória no idoso com comorbilidade respiratória pós-cirurgia ortopédica. Método: Estudo quantitativo, quase-experimental, longitudinal, de grupo único. A amostra foi constituída por 30 (n=30) utentes com idade compreendida entre 65 e 84 anos, intervencionados cirurgicamente à anca ou joelho, obtiveram-se aleatoriamente 15 utentes de cada tipo de intervenção. O programa de reabilitação respiratória decorreu durante 4 semanas. Avaliou-se o impacto da dependência e da dispneia nos autocuidados: banho, mobilidade, subir e descer escadas e vestir através do Índice de Barthel e da Escala Modificada de Borg, respetivamente. Resultados: Não se evidenciaram relações estaticamente significativas entre o grau de independência e o grau de dispneia com as variáveis género, habilitações literárias, estado civil, diagnóstico, IMC, complicações pós-operatórias, medicação, destino da alta e tempo de restrição de mobilidade. Relativamente ao grau de dependência e de dispneia verificou-se regressão à medida que o programa de reabilitação respiratória progredia, constatando-se uma evolução positiva desde a primeira à quarta avaliação. Na primeira avaliação verificou-se um grau grave de dependência (M=57,33) evoluindo para um grau de muito leve dependência na quarta avaliação após o programa de reabilitação respiratória (M=96,83), pelo que podemos concluir que o programa contribuiu para a regressão da dependência e melhorou a capacidade para a realização dos autocuidados banho, mobilidade, subir/descer escadas e vestir. No que se refere ao grau de dispneia, verificam-se diferenças estatisticamente significativas após aplicação do programa. Conclusão: A implementação do programa de reabilitação respiratória pós-cirurgia, pelo Enfermeiro de Reabilitação, revelou benefícios, com diminuição do grau de dependência nomeadamente para os autocuidados banho, mobilidade, subir e descer escadas e vestir e ainda efeito positivo na regressão do grau de dispneia, verificando-se diferenças estatisticamente significativas quer nos utentes submetidos a cirurgia à anca ou ao joelho. No entanto, é crucial a realização de mais estudos neste âmbito, de forma a comprovar a efetividade do papel da enfermagem de reabilitação respiratória na prática clínica.

With the improvement of therapeutic and socio-economic processes, there is a rapid demographic transition, reflected in an increase in life expectancy, but also in an exponential increase in the number of elderly people with chronic diseases and consequently in a situation of dependency. In Portugal, individuals over 65 represent about 20% of the entire population, which has obvious implications for respiratory health. The high prevalence of respiratory pathology emerges as one of the most influent chronic diseases in the elderly. In addition, in hospital inpatient services, orthopedic surgery represents higher occupancy rates in individuals over 65 years of age. Surgeries imply mobility restriction and from this comes dependence and dyspnea on self-care. Respiratory Rehabilitation is therefore crucial. The present study has as main objective to evaluate the effect of a program of respiratory rehabilitation in the elderly after orthopedic surgery. Method: Quantitative, quasi-experimental, longitudinal, single group study. The sample consisted of 30 (n = 30) patients aged between 65 and 84 years, surgically operated on the hip or knee, 15 patients (n = 15) were randomly assigned to each type of intervention. The sample participated in the respiratory rehabilitation program for 4 weeks. The impact of dependence and dyspnea was evaluated through the Barthel Index and the Modified Borg Scale, respectively, namely for self-care: bathing, mobility, climbing and descending stairs and dressing. Results: There were no statistically significant relationships between the degree of independence and the degree of dyspnea with sociodemographic variables (gender, literacy, marital status) and clinical variables (diagnosis, BMI, postoperative complications, medication, discharge and time of mobility restriction). The results indicated contributions from the respiratory rehabilitation program in the regression of the degree of dependence and of dyspnea, both the degree of dependence and the degree of dyspnea were reverted as the respiratory rehabilitation program progressed, denoting a greater difference of values between the first and fourth evaluation. The Barthel Index presented a severe degree of dependence (M = 57.33) in the first evaluation, for a very mild degree of dependence in the fourth evaluation after the respiratory rehabilitation program (M = 96.83). The program regains dependency, improves the capacity for self-care (bathing, mobility, climbing / descending stairs and dressing). After the program, statistically significant values are outlined in all assessments of the degree of dyspnea for these self-care. Conclusion: The implementation of the postoperative respiratory rehabilitation program, by the Rehabilitation Nurse, revealed benefits, with a decrease in the degree of dependence namely for self-care bathing, mobility, climbing and descending stairs and dressing, and still positive effect in the regression of the degree of dyspnea, with statistically significant differences. However, it is crucial to carry out further studies in this field, in order to prove the effectiveness of the role of respiratory rehabilitation nursing in clinical practice.

[Osteoporosis treatment in patients over 75 years old with fractures living in nursing home]. / Prise en charge de l'ostéoporose fracturaire chez les patients de plus de 75 ans vivant en institution.

OBJECTIVE: Recommendations for the management of major fractures in institutionalized patients over 75 years old were updated by the GRIO (French group for research and information on osteoporosis) in 2012 and in 2018. This study is an evaluation of practices in osteoporosis management in institutionalized old patients. METHODS: Evaluation of diagnostic and therapeutic management in medical observations of all residents over 75 years old with a history of major fracture in 4 nursing homes. RESULTS: 105 residents were included with the prevalence of osteoporosis fracture of 32.1%. The most common fractures were hip fractures (60.9%) and vertebral fracture (45.8%). Treatments were: calcium supplementation (14.3% of residents), vitamin D (52.4%), rehabilitation (70.5%) and specific treatment (biphosphonates 11.4%). Complete management (calcium supplementation, vitamin D, physical activity and osteoporosis treatment) was found in 5 residents (4.7%). Few factors were related to complete treatment initiation. Residents initially managed in medicine departments were more treated than those in surgical wards (25.0 vs 6.5%; p = 0.0144) rather than those managed by specialists (rheumatologist or geriatrician: 8 vs 4; p < 0.001). Creatinine clearance was significantly higher in residents with calcium supplementation (52.7 ± 27.9 vs 39.1 ± 9.6; p = 0.0505). Regimen number tend to be higher in residents receiving vitamin D (8.9 ± 2.7 vs 6.7 ± 3.4; p = 0.0753). CONCLUSION: This evaluation of professional practices showed that only a minority of residents received complete anti-osteoporotic treatment despite their risk factor for fracture recurrence. Such an evaluation should be systematic at the entry in nursing home, given the number of falling residents.

Creating conditions for a sense of security during the evenings and nights among older persons receiving home health care in ordinary housing: a participatory appreciative action and reflection study.

BACKGROUND: Today many older persons in ordinary housing receive home health care. It is stipulated that the care is to provide security; however, deficiencies in home health care are reported in many countries. It may be difficult to implement a sense of security among older persons receiving home health care in ordinary housing, especially during the evenings and nights, due to a lack of knowledge. METHODS: This study is part of a larger project with a participatory appreciative action and reflection (PAAR) approach. We invited older persons, relatives, nurse assistants, registered nurses, and their managers to co-create knowledge with us on how conditions for a sense of security can be created during evenings and nights among older persons receiving home health care in ordinary housing. We performed thematic analysis of the data. RESULTS: Five subthemes were developed that gave structure to two main themes. The first main theme, To confirm the self-image, has the following subthemes: To see the home as a reflection of the person's identity and To maintain self-determination. The second main theme, To create interaction in a sheltered place, has these subthemes: To undress the power, To create control and lifelines, and To create a good sleeping environment. The two themes interact and are each other's conditions. The person's self-image must be confirmed in order to create interaction in a sheltered place and through the interaction, the self-image is confirmed. CONCLUSION: Conditions necessary for older persons to have a sense of security are living in a familiar environment, having habits and routines maintained, and having self-determination. Other conditions are equality, the prevention of falls, and an individualized sleeping environment. Older people's self-determination should be honored, and they should not being excluded from decision-making. We need to ask them if the conditions are sufficient and their sense of security is great enough to allow them to continue living in their ordinary housing.

Process evaluation of a complex intervention to optimize quality of prescribing in nursing homes (COME-ON study).

BACKGROUND: The COME-ON study was a cluster-controlled trial of a complex intervention that consisted of a blended training program, local interdisciplinary meetings, and interdisciplinary case conferences in Belgian nursing homes. The intervention was associated with significant improvements in the appropriateness of prescribing. The aims of this study were to describe the implementation of the intervention and to explore the experiences of participants, for the purpose of identifying factors associated with implementation and perceived impact and to draw lessons for future implementation. METHODS: We performed a mixed-method process evaluation. Questionnaires and reports were used to collect quantitative data on implementation and experiences from the 24 NHs and participating healthcare professionals (coordinating physicians, general practitioners, pharmacists, and nurses) in the intervention group. Multidisciplinary focus groups focusing on factors associated with implementation and perceived impact were conducted in 11 NHs. RESULTS: Overall, the rate of implementation and the satisfaction of participants were good, despite some variability between NHs and HCPs. Although perceived impact on nursing home residents varied, most participants perceived a positive impact for themselves. Factors associated with implementation and perceived impact were identified at different levels: intervention, healthcare professionals, organization, and external context. The interdisciplinary and face-to-face approaches were recognized as key elements for the success of the intervention, despite organizational constraints. The attitude of general practitioners was identified both as a barrier to and a facilitator for implementation and its success. The professional role and competency of the pharmacist influenced perceived impact. The pre-existing relationships between HCPs and the presence of a leader facilitated implementation and perceived impact. Remuneration was deemed necessary for the study and for future implementation. CONCLUSIONS: Overall, the intervention, and more specifically its interdisciplinary aspect, was well implemented and appreciated by HCPs. This probably contributed to the positive effect on the appropriateness of prescribing. Future implementation must take into account the various factors found to affect implementation and perceived impact, in order to maximize effect and sustainability. Trial registration Current Controlled Trials ISRCTN66138978; registered 18 November 2015, retrospectively registered, https://www.isrctn.com/ISRCTN66138978.

Perception of nursing workers on the care of hypertension in older adult.

OBJECTIVE: To understand how nursing workers perceive care of hypertension (HBP) in older adult within the scope of the Family Health Strategy. METHOD: A qualitative descriptive study carried out in the city of Natal/RN, with 20 nursing workers providing care to older adults with HBP. The data were obtained through a semi-structured interview and analysed by the Thematic Analysis, based on the theoretical support of the integrality, using Atlas.ti 7.0 software. RESULTS: The elements found as facilitators were: territorialization, partnerships, professional proactivity and the user's bond with the team. Among those found as barriers were: disease-centered care; academic education based on the biomedical model; lack of inter-sectorality and discontinuity of care in the care network. FINAL CONSIDERATIONS: Nursing workers perceive that health institutions lack articulated and innovative practices that incorporate new paradigms focused on integrality of care.

Political and pedagogical projects of nursing residency to the elderly from Paulo Freire's perspective.

OBJECTIVE: to analyze political and pedagogical projects of nursing residency to the elderly from Paulo Freire's perspective. METHOD: a descriptive, exploratory study, qualitative approach using documentary analysis. Data source was pedagogical political projects of nursing residency programs in the health of the elderly. The data were collected between March and May 2017. Data analysis was based on Bardin's Thematic Analysis. It had as analytical categories specific dimensions of the proposed theoretical framework. RESULTS: twelve pedagogical political projects showed that learning dimensions appear in an incipient, fragmented way, demonstrating the reproduction of banking education, disregarding the importance of bringing the student as a subject of learning. CONCLUSION: there is a gap in pedagogical political projects from Paulo Freire's perspective. It is necessary that regulatory institutions can systematize and encourage so that pedagogical projects of these programs are based on Paulo Freire's epistemological bases, enabling the so desired holistic training.

Aging, sexuality and nursing care: the elderly woman's look.

OBJECTIVE: to analyze the perception of elderly women about sexuality and practice of nursing care in this context. METHOD: a descriptive qualitative study. Fifty elderly women from Guanambi City - Bahia State were interviewed in 2016. Data collection technique was direct interview by using an unstructured script. Analysis of the semantic content described was carried out, and two empirical categories: the elderly woman's view of nursing care in the promotion of sexual health and experience of sexuality in the elderly; and nursing care in the context of women's aging. RESULTS: it has been noted that the elderly women are afraid to talk about sexuality, especially with health professionals. By influences of society, they often exclude this issue of health care for elderly women. FINAL CONSIDERATIONS: changes must be thought about assistance provided in relation to sexuality.

The labor market in gerontological nursing in Brazil.

OBJECTIVE: to analyze the development of the labor market in Gerontological Nursing in Brazil, between 1970 and 1996. METHOD: a descriptive-qualitative study with a historical approach that uses the oral history of 14 research nurses working in the historical period, based on the ideas of Eliot Freidson. RESULTS: Nursing overcame barriers to change the care practices to elderly people in the period described, considering the lack of a specific labor market; the need for theoretical knowledge for Gerontology care; the scarcity of research and researchers in the field; the emergence of caregivers for elderly people; the construction of multidisciplinarity and the transformation of institutions for a long-term stay. FINAL CONSIDERATIONS: the expansion of the labor market at the time was grounded on advances on the production of knowledge of the aging process, supported by the demographic transition, that determined the increase in the demand by elderly people for health services and the enactment of specific laws protecting this population.

ICNP ® nursing diagnoses, outcomes and interventions for community elderly.

OBJECTIVE: To construct a nomenclature of nursing diagnoses, outcomes and interventions for elderly people under follow-up in the Family Health Strategy by using the International Classification for Nursing Practice and the theoretical reference of Virginia Henderson. METHOD: Methodological study developed according to guidelines of the International Council of Nurses. RESULTS: A total of 127 concepts of nursing diagnoses/outcomes were constructed and distributed according to nursing care components in the subcategories of Biological/Physiological, Psychological, Social and Spiritual/Moral components. For these diagnoses, were proposed 551 nursing interventions. CONCLUSION: The concepts constructed may favor integral care for the elderly in the Family Health Strategy and the structuring of a terminological subset for this clientele.

Nurse care for the hospitalized elderly's spiritual dimension.

OBJECTIVE: to analyze the nurse care for the spiritual hospitalized elderly's dimension. METHOD: a qualitative study, based on Jean Watson's Theory of Human Caring. The study included 17 nurses working in a geriatric center in Salvador City, Bahia State, Brazil. The collection of testimonies occurred between January and April of 2018, through an interview. RESULTS: spiritual care were dialogue, encouragement and respect for religious activities, embracement, empathy. One of the obstacles to providing this care was the lack of preparation in accessing the elderly's spiritual dimension. FINAL CONSIDERATIONS: spirituality is a dimension of human and holistic nursing care. Caring for the spirit contributes to foster transpersonal care. The difficulty may be in the lack of nurses' preparation. It is necessary that they cultivate and live their own spirituality, transmitting the understanding in each care relationship.

Advanced mobile prehospital nursing care for elderly people post-trauma: integrative review.

OBJECTIVE: to identify scientific evidences available on the literature on nursing interventions on advanced mobile prehospital care for elderly people post-trauma. METHOD: an integrative review of literature on the databases PubMed, CINAHL, and LILACS, from 2012 to 2017. RESULTS: a sample composed by 26 studies, grouped into six thematic categories: circulation with hemorrhage control (n=11); dysfunction, neurological state (n=7); airway with protection of the cervical spine (n=3); secondary evaluation (n=3); ventilation and breathing (n=1), and environment exposition/control (n=1). CONCLUSION: Despite having identified nursing interventions, there was no description of specific nursing interventions related to advanced mobile prehospital care for elderly people post-trauma.

Assumptions of good practices in home care for the elderly: a systematic review.

OBJECTIVE: To synthesize the knowledge produced on best nursing practices in long-term care for elderly at home, in order to promote healthy aging. METHOD: A systematic review, based on the Joanna Briggs Institute's proposal: without restriction of dates; in the English, Portuguese and Spanish languages; conducted in PubMed, CINAHL, LILACS, Embase and Scopus databases. RESULTS: Among 453 articles identified, 16 were included in the review: seven qualitative and nine quantitative, published between 1996 and 2015. The synthesis of the data identified as best practices identifies a premise of care centered on the elderly and the inclusion of the elderly, family and nurses as agents of this care. CONCLUSION: According to evidence, good practices in gerontological and nursing home care fundamentally depend on constant planning and reorganization, so that they are indeed comprehensive and contextualized. Thus, providing care will be reasoned by and driven to the elderly, based on their specific and global needs, favoring a process of healthy and active aging.

Care under the guidance of pressure injury prevention protocol: a nursing home sample.

Pressure injury is a healthcare problem frequently encountered in nursing homes. This study evaluated the effects of the care delivered under the guidance of a protocol for pressure injury prevention at a nursing home. It was implemented in four phases. In the pre-protocol period, the pressure injury incidence and nurses' care practices were evaluated. In the second phase, nurses were trained to use the protocol. In the third phase, the nurses provided care under the guidance of the protocol (post-protocol period). In the fourth phase, the incidence of pressure injury and nurses' care practices were compared between the pre- and post-protocol periods. The average age of the older residents was 78.40±7.12 years, and all were at high or very high risk of pressure injury according to the Braden scale scores. Some 30% were bed bound; 90% had faecal and urinary incontinence; and 70% had malnutrition. The results showed that the pressure injury incidence reduced from 17.39% in the pre-protocol period to 10.87% in the post-protocol period, while the nurses' care practices improved in the post-protocol period. Thus, use of pressure injury-prevention protocols can reduce the incidence of these injuries in vulnerable care home residents.

Comparison of prevalence and associated risk factors of cognitive function status among elderly between nursing homes and common communities of China: A STROBE-compliant observational study.

Dementia among elderly is a serious problem worldwide. This study was conducted to estimate the prevalence and associated risk factors of dementia and mild cognitive impairment (MCI) in nursing homes (NHs) and common communities (CCs) among elderly in China.A cross-sectional survey was conducted in 4 communities across 12 cities in Southern China from May to November of 2014. Qualified psychiatrists and trained nurses carried out relevant diagnosis, assessments, interviews, and information collection. Screening test of mini-mental state examination was conducted among participants firstly, then confirmed diagnosis was carried out among the ones with positive results. Student t test, χ test, univariate, and multivariate logistic regression analysis were conducted to analyze data.A total of 2015 participants aged 65 or older were included in the final analysis; 908 came from NHs while 1107 came from CCs. The crude prevalence rates of dementia and MCI were 22.0% and 15.8%, respectively among all the participants. Dementia prevalence was 42.4% among those living in NHs, which was significantly higher than that of 5.3% in CCs (P < .0001). There were more moderate and severe dementia in NHs compared with CCs (P < .0001). It showed that older age, illiterate compared with high level of education (adjusted odds ratio, AOR = 3.32, 95% CI: 1.53-7.21), heavy drinking (AOR = 1.51 (1.00-2.24), having a medical history of diabetes (AOR = 1.41, 95% CI: 1.02-2.33), and stroke (AOR = 1.21, 95% CI: 1.01-1.23) were associated with dementia in NHs, and middle socioeconomic status might be a protective factor for dementia (AOR = 0.33, 95% CI: 0.21-0.51).The problem of senile dementia in NHs is much more serious than our estimation, and there are not enough trained nursing staffs in NHs. More population-based strategies in NHs, including conducting cognitive screening accompanied with routine physical examination among elderly population, carrying out related primary prevention policies and public health services, and paying attention to some modifiable associated risk factors such as heavy smoking and drinking are needed.

Effectiveness of multidisciplinary psychiatric home treatment for elderly patients with mental illness: a systematic review of empirical studies.

BACKGROUND: The vast majority of older people with mental illness prefer to live independently in their own homes. Barriers caused by the health care system often prevent adequate, adapted treatments. With regard to the increasing ageing of the population, the determination of effective, age-appropriate service models for elderly patients with mental illness is clearly required. The aim of this review is to examine and to evaluate multidisciplinary psychogeriatric treatment models that include home visits, particularly with regard to the effects on psychiatric symptoms, social and mental health rehabilitation and quality of life. METHODS: A systematic review was carried out of empirical studies with participants who were diagnosed with a mental illness according to ICD-10, aged 60 years or older, and who were living at home. The inclusion criteria comprised a duration of intervention of at least 12 weeks and a minimum of two interventions and domiciliary visits delivered by a multidisciplinary team. The online databases Medline, PsychInfo, Web of Science, Cochrane Register of Controlled Trials, and Google Scholar, as well as hand search, were used to search for relevant studies published between 1996 and 2016. An additional search was performed for studies published between 2016 and 2019. After removing duplicates, abstracts were screened and the remaining articles were included for full-text review. RESULTS: Of the 3536 records discovered in total, 260 abstracts appeared to be potentially eligible. Of these, 30 full-text articles were assessed for eligibility. For the additional search 415 records and abstracts were screened and 11 articles were read full text. Finally, only three studies fully met the inclusion criteria for this review. The results indicate that psychogeriatric home treatment is associated with significant improvements of psychiatric symptoms and psychosocial problems, fewer admissions to hospital and nursing homes, as well as lower costs of care. CONCLUSIONS: Psychogeriatric home treatment has positive effects on older people with mental illness. However, these findings are based upon a small number of studies. The need for further research, especially to specify the effective factors in psychogeriatric home treatment, is clearly indicated.

Knowledge about the Care of People with Alzheimer's Disease of the Nursing Staff of Nursing Homes in Spain.

People with Alzheimer's disease often live in nursing homes. Updated knowledge among the nursing staff has led to better quality of care. The aim of this study was to measure the knowledge about the care of people with Alzheimer's disease of the nursing staff of nursing homes in Spain. A cross-sectional study was conducted in 24 nursing homes in the province of Jaén (Spain) with a sample of 361 members of staff, i.e., registered nurses (RNs), assistant nurses (ANs), and eldercare workers (EWs). The University of Jaén UJA-Alzheimer's Care Scale was used to measure the knowledge. The knowledge was higher among the RNs (83.3% of the maximum) than among the ANs and EWs (71.6%). Work experience and updated training were associated with the knowledge score in RNs, but only the updated training in ANs and EWs. Nursing homes with less experienced nursing staff and with a small proportion of staff receiving training on dementia have a low knowledge score. The nursing staff of nursing homes in Jaén have medium to high knowledge about Alzheimer's care. There is a wide range of variation in the knowledge score among the nursing homes. Up-to-date staff training in dementia care is the factor with the strongest association with knowledge.

On-call simulation for adult gerontology acute care nurse practitioner students: A comparative descriptive study.

BACKGROUND: It is now commonplace for acute care nurse practitioners (ACNPs) to work in positions that include an on-call component or management of emergent concerns through telephone. There are no published reports on the inclusion of an on-call component in ACNP clinical preparation of students; novice ACNPs feel unprepared to competently and confidently manage emergent patient situations and on-call responsibilities. PURPOSE: To examine ACNP student perception of stress, necessary skills, confidence, and benefit of participating in a simulated on-call experience. METHODS: Using simulated faculty callers as nurses, ACNP students participated in a simulated on-call experience that included receiving two calls, eliciting key information from the nurse, diagnosing and managing the patient, and submitting documentation of the encounter. Students completed preparticipation and postparticipation perception surveys, and they were evaluated by the simulated nurse (faculty) using standardized evaluation tools. RESULTS: Acute care nurse practitioner students rated the simulated on-call experience as educationally valuable. High levels of anxiety before participation were notably improved after participation. Students identified critical thinking, clear communication, and knowledge with the specific disease as the most important skills needed to manage nurse calls successfully. Students reported marked improvement in their confidence and were receptive to accepting an nurse practitioner position with call/triage responsibilities after their on-call experience. IMPLICATIONS FOR PRACTICE: Inclusion of a simulated on-call experience in the final semester of an ACNP program is both feasible and relevant to ACNP student development. On-call exposure within the clinical practicum is inconsistent and, therefore, should be added through simulation.

A multicomponent exercise intervention to improve physical functioning, cognition and psychosocial well-being in elderly nursing home residents: a study protocol of a randomized controlled trial in the PROCARE (prevention and occupational health in long-term care) project.

BACKGROUND: Older adults, who are living in nursing homes that provide a high level of long-term nursing care, are characterized by multimorbidity and a high prevalence of dependency in activities of daily living. Results of recent studies indicate positive effects of structured exercise programs during long-term care for physical functioning, cognition, and psychosocial well-being. However, for frail elderly the evidence remains inconsistent. There are no evidence-based guidelines for exercises for nursing home residents that consider their individual deficits and capacities. Therefore, high-quality studies are required to examine the efficacy of exercise interventions for this multimorbid target group. The purpose of this study is to determine the feasibility and efficacy of a multicomponent exercise intervention for nursing home residents that aims to improve physical and cognitive functioning as well as quality of life. METHODS: A two-arm single-blinded multicenter randomized controlled trial will be conducted, including 48 nursing homes in eight regions of Germany with an estimated sample size of 1120 individuals. Participants will be randomly assigned to either a training or a waiting time control group. For a period of 16 weeks the training group will meet twice a week for group-based sessions (45-60 min each), which will contain exercises to improve physical functioning (strength, endurance, balance, flexibility) and cognitive-motor skills (dual-task). The intervention is organized as a progressive challenge which is successively adapted to the residents' capacities. Physical functioning, cognitive performance, and quality of life will be assessed in both study groups at baseline (pre-test), after 16-weeks (post-treatment), and after 32-weeks (retention test, intervention group only). DISCUSSION: This study will provide information about the efficacy of a multicomponent exercise program in nursing homes (performance, recruitment). Results from this trial will contribute to the evidence of multicomponent exercises, which specifically focus on cognitive-motor approaches in the maintenance of mental and physical functioning. In addition, it will help to encourage older adults to actively engage in social life. Furthermore, the findings will lead to recommendations for health promotion interventions for frail nursing home residents. TRIAL REGISTRATION: The trial was prospectively registered at DRKS.de with the registration number DRKS00014957 on October 9, 2018.