Supporting Mealtime Participation Among People Living With Dementia at Home: Challenges and Strategies for Caregivers.

BACKGROUND AND OBJECTIVES: Approximately 60% of people living with dementia at home are unable to routinely participate in mealtime activities (e.g., eating, safe food preparation), warranting assistance to ensure people with dementia meet their health and nutritional needs. The purpose of this study was to characterize these barriers to mealtime participation and identify potential caregiver-led strategies to enhance mealtime activities. RESEARCH DESIGN AND METHODS: We used a qualitative descriptive approach and obtained semistructured interview data from (a) allied health professionals and (b) community-based nutrition program providers who frequently serve people with dementia. Interview data were examined by means of directed content analysis and framework methodology until data saturation was reached. Codes from our analysis were categorized according to constructs drawn from the Socio-Ecological Model for Developing and Implementing Comprehensive Dementia Care. RESULTS: Data were obtained from 20 participants who attributed common mealtime participation barriers to: impairments in functional status, cognitive status deficits, a lack of caregiver knowledge and skills, and unsafe living conditions. Caregiver-led strategies to overcome these barriers included: reducing auditory and visual distractions, providing written cues to perform mealtime activities, eliminating clutter and fall risk hazards, and leveraging community-based nutrition program providers (e.g., home-delivered meal providers). DISCUSSION AND IMPLICATIONS: People with dementia face several eating and mealtime participation obstacles. Caregiver-led strategies implemented by family, friends, or community-based nutrition program providers may enhance mealtime activities at home. Findings point to opportunities to develop decision-making tools and resources for caregivers to optimize the health and nutrition of people with dementia.

Implementing CAPABLE With Care Partners Through an Area Agency on Aging: Identifying Barriers and Facilitators Using the Consolidated Framework for Implementation Research.

BACKGROUND AND OBJECTIVES: Community Aging in Place, Advancing Better Living for Elders (CAPABLE) is an evidence-based intervention to promote aging in place. Although CAPABLE has been implemented in more than 40 community sites, wide variation in implementation exists. Guided by the Consolidated Framework for Implementation Research (CFIR), this study sought to determine key barriers and facilitators that may influence CAPABLE implementation with older adult and care partner dyads through an area agency on aging (AAA). RESEARCH DESIGN AND METHODS: A formative evaluation was completed using qualitative data from the pilot of a Hybrid Trial Type 1 study implementing CAPABLE in an AAA. Multiple sources of data were collected, including 2 focus groups, field notes, a tracking log, and meetings with CAPABLE interventionists. Data were analyzed using a framework method and validated through a negative case analysis approach in NVivo 12 Pro. RESULTS: Fourteen dyads enrolled in the pilot and 6 completed the CAPABLE intervention. Key themes aligned with 10 constructs from 5 domains of the CFIR. Facilitators included adaptability of the intervention, cost, networks and communication, and knowledge and belief of individuals. Barriers included intervention complexity, client needs and resources, and executing the planned process. DISCUSSION AND IMPLICATIONS: Results enhance understanding of contextual factors that can influence the implementation of CAPABLE with care partners. Strategies to overcome barriers include simplifying recruitment materials and targeting older adults with recent onset of disability. The CFIR is a valuable resource for planning and evaluation of the implementation of evidence-based interventions to promote aging in place.

Hippotherapy Practice and Safety Patterns in the United States: A Descriptive Survey Study.

Objective: The use of equine movement as a therapy tool in a plan of care, or hippotherapy, has grown considerably over the past three decades. However, there is little evidence of safety rates and related practice patterns to guide key stakeholders such as clients, therapists, the health care team, and third-party payers. The purpose of this article is to describe the safety and practice patterns of contemporary use of hippotherapy. Design: A survey was distributed to occupational therapy (OT), physical therapy (PT), and speech-language pathology clinicians who incorporate hippotherapy into their practice. The survey included questions about clinicians' practice patterns, safety procedures, and rates of safety incidents. Results: Results indicate that hippotherapy is most often used by PT and OT clinicians for pediatric clients. Use of hippotherapy varies by geographic location, and frequency and duration vary widely. Clinicians most often contract their services to a program that provides a facility and horses. Recommended safety practices are widely adopted, and rates of safety incidents requiring basic first aid (0.05% of sessions) or off-site care (0.01% of sessions) are low. Emergency dismounts are frequently practiced and often effective in preventing an incident. Conclusions: Although there are inherent risks to incorporating horses into a therapeutic plan of care, these risks appear to be well managed by recommended safety practices. Results of this study can (1) help clinicians to make informed decisions regarding practice and safety procedures, (2) provide evidence of safety practices and incident rates to clients, members of the health care team, and third-party payers, and (3) maximize safety for clients who participate in hippotherapy.