Resident-, family-, and staff-identified goals for rehabilitation of long-term care residents with dementia: a qualitative study.

BACKGROUND: Long-term care (LTC) residents with dementia can benefit from rehabilitation to improve function and quality of life. However, specific goals for rehabilitation with this population are not always clear. The purpose of this study was to describe the goals for rehabilitation for LTC residents with dementia from the perspective of residents, family, and staff. METHODS: This was a phenomenological qualitative study. LTC residents with moderate to severe dementia, family members, and staff were recruited from two LTC homes in Halifax, Nova Scotia. Data were collected through semi-structured interviews and field notes from observations with residents while they were being active within the home. Data were analyzed via the principles of thematic content analysis, mapped onto the International Classification of Functioning, Disability, and Health (ICF) Model, and reported by the participant group (i.e., residents, family, or staff). RESULTS: The 15 participants were three female residents aged 82 to 98 years, seven predominantly (86%) female family members aged 56 to 74 years, and five staff members (two females, three males, aged 22 to 55 years) who were physiotherapists, a physiotherapy assistant, a healthcare aide, and a registered licenced practical nurse. Most identified goals fell within the activities and participation constructs of the ICF model and focused on maintaining or improving function, mobility, and quality of life. Specific themes included preventing falls, walking or locomoting, stair climbing, maintaining activities of daily living, engaging in enjoyable exercise, maintaining independence and human connections, keeping busy, leaving the home for activities, and participating in group activities. CONCLUSIONS: Rehabilitation goals for LTC residents living with dementia often focus on quality of life and functional activities and participation in LTC and family activities and events. Function and quality of life are interrelated, whereby functional goals influence quality of life. While some goals focus on improvement in function, maintenance or prevention of decline were also key elements. Future work should ensure rehabilitation interventions are developed relative to individually identified goals, and interventional success is measured in relation to the goal.

Effectiveness of physical rehabilitation for physical functioning and quality of life in long-term care residents with dementia: a systematic review and meta-analysis.

OBJECTIVE: The objective of this review was to evaluate the effectiveness of physical rehabilitation vs non-rehabilitation comparators for physical functioning and quality of life in long-term care (LTC) residents with dementia. INTRODUCTION: LTC residents living with dementia often have impaired physical functioning and quality of life. Physical rehabilitation can improve physical functioning and quality of life for individuals living with dementia; however, many LTC residents with dementia do not receive physical rehabilitation and providers are unsure what interventions to employ. A synthesis of studies examining physical rehabilitation will help guide practice in the LTC sector where most residents live with dementia. Previous syntheses have focused on all residents in LTC, specific professions, interventions, or people with dementia in the community. Our review focused on LTC residents with dementia and used a broader definition of physical rehabilitation. INCLUSION CRITERIA: This review included studies that evaluated physical rehabilitation in comparison with non-rehabilitation controls among LTC residents with any severity of dementia. We included experimental and quasi-experimental studies that measured the effect on activities of daily living, performance-based physical functioning, and self- or proxy-rated quality of life. METHODS: Searches were conducted in APA PsycINFO (EBSCOhost), CINAHL (EBSCOhost), PubMed (National Library of Medicine), Embase, Scopus, and the Cochrane CENTRAL database with no date or language limitations. Two independent reviewers assessed the studies against the inclusion criteria. Two independent reviewers extracted data and conducted a methodological quality assessment using standardized checklists from JBI. Certainty of evidence was ascertained using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Where possible, studies were pooled in meta-analyses; otherwise, a narrative synthesis was presented. RESULTS: Thirty-three studies were included (n=3072 participants); 27 were randomized controlled trials and (RCTs) the remaining 6 were non-randomized trials. The overall risk of bias of the included studies was low to unclear. Many of the included studies focused on increasing activity or walking, while few were individually tailored or at an intensity appropriate to induce therapeutic effects on physical function. Physical function was measured via several outcome measures, limiting our ability to pool results. There was low-certainty evidence that physical rehabilitation improved activities of daily living assessed with multiple instruments (12 RCTs, 1348 participants, standardized mean difference [SMD] 0.78; 95% CI 0.27 to 1.30) and lower extremity function assessed with the Short Physical Performance Battery Score (3 RCTs, 258 participants, mean difference [MD] 3.01 points; 95% CI 1.37 to 4.66), compared with non-rehabilitation interventions. There was very low- to moderate-certainty evidence that physical rehabilitation demonstrated no change in the 30-Second Sit to Stand Test (2 RCTs, 293 participants, MD 0.79 repetitions; 95% CI -0.45 to 2.03), 6-Minute Walk Test (4 RCTs, 363 participants, MD 17.32 meters; 95% CI -29.41 to 64.05), Timed Walk Test (4 RCTs, 400 participants, MD 0.10 meters/seconds; 95% CI -0.02 to 0.22), Timed Up and Go Test (3 RCTs, 275 participants, MD -2.89 seconds; 95% CI -6.62 to 0.84), or quality of life (4 RCTs, 419 participants, SMD 0.20; 95% CI -0.08 to 0.47). CONCLUSIONS: This review demonstrates that physical rehabilitation may improve activities of daily living for LTC residents living with dementia, although the evidence is of low certainty. The effect of physical rehabilitation on specific functional tasks, such as gait speed and quality of life, are less clear. Future research should examine the effects of individualized, progressive interventions on outcome measures that reflect the capacity and preferences of LTC residents with more advanced dementia. REVIEW REGISTRATION: PROSPERO CRD42022308444.

Scoping review of methods for engaging long-term care residents living with dementia in research and guideline development.

OBJECTIVES: To describe: (1) methods used to engage long-term care (LTC) residents living with dementia in research and guideline development; (2) the outcomes of engagement; and (3) barriers and facilitators to engagement. DESIGN: Scoping review. SEARCH STRATEGY: We conducted searches in Academic Search Premier (EBSCO), APA PsychInfo (EBSCO), CINAHL (EBSCO), Medline (OVID), Embase (Elsevier), Web of Science and the Cochrane database, and a structured grey literature search in July 2021 and updated in March 2023. We included studies that described or evaluated resident engagement, defined as including residents living with dementia in the process of developing healthcare guidelines or research which could include collaborators or partners in planning, execution or dissemination of the guideline or research. Title, abstracts and full-texts were screened for eligibility by two team members using a pilot-tested process. Data were extracted from included studies independently and in duplicate by two team members using a pre-tested data extraction form. Results were narratively synthesised according to the research question they addressed. RESULTS: We identified three studies for inclusion. Residents were engaged at the beginning of the research projects through interviews, focus groups, and consultations. None of the included articles described the outcomes of engagement. Barriers to engagement were predominantly at the resident level, including impaired verbal communication limiting resident's abilities to participate in discussions, while increased time to support engagement was reported as a barrier at the resident and research team levels. CONCLUSIONS: We found a small body of literature describing the engagement of LTC residents in health research and guideline development. Future work should explore alternative methods to engage LTC residents living with dementia, including art-based methods, and the effect of including resident engagement. Guideline developers and researchers should ensure adequate time and human resources are allocated to support engagement.

Effectiveness of physical rehabilitation in improving physical functioning and quality of life for long-term-care residents with dementia: a systematic review protocol.

OBJECTIVE: The objective of this review is to evaluate the effectiveness of physical rehabilitation versus non-rehabilitation control in improving physical functioning and quality of life in long-term care residents with dementia. INTRODUCTION: Many long-term-care residents live with dementia and have impaired physical function and poor quality of life. Physical rehabilitation can improve physical function and quality of life for people living with dementia, yet many long-term-care residents with dementia do not receive this intervention, and health care providers are unsure of which rehabilitation interventions are effective. Studies synthesizing effective rehabilitation programs are needed to guide practice in the long-term-care sector where many residents live with dementia. Previous studies have focused broadly on long-term care, specific professions, interventions or outcomes, or people with dementia in the community. Our review will focus on long-term-care residents living with dementia and a broader definition of physical rehabilitation. INCLUSION CRITERIA: This review will include studies that evaluate physical rehabilitation in comparison with non-rehabilitation controls among long-term-care residents with any severity of dementia. We will include studies that measure the effect on performance-based physical functioning and self- or proxy-reported quality of life. METHODS: Searches will be conducted in APA PsycINFO (EBSCO), CINAHL (EBSCO), MEDLINE (Ovid), Embase, Scopus, and the Cochrane CENTRAL database with no date or language limitations. Two independent reviewers will conduct a critical appraisal of eligible studies, assess methodological quality, and extract the data. Where possible, studies will be pooled in a statistical meta-analysis. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42022308444.