Physical Performance of Individuals Living with Dementia in. Nursing Homes: A. Randomized Controlled. Trial. University of. Wollongong. Brett, L., Traynor, V. &.
FOCUS: Aged Care
EXERCISE FOR INDIVIDUALS LIVING WITH DEMENTIA IN RESIDENTIAL AGED CARE FACILITIES: A NEGLECTED ISSUE By Lindsey Brett and Victoria Traynor Most health professionals working in residential aged care facilities (RACFs) will agree that physiotherapy and exercise for individuals living with dementia is a neglected area, even though there is evidence that demonstrates numerous benefits. A systematic review found studies demonstrated significant improvements in cognition, agitation, mood, mobility and functional ability for individuals living with dementia in RACFs when they participated in exercise (Brett et al. 2016b). Recent Australian studies have also demonstrated the feasibility of physiotherapy and exercise for individuals living with dementia in RACFs, as well as improvements in functional ability and behavioural and psychological symptoms of dementia (Brett et al. 2017; Brett et al. 2016a; Neville et al. 2014; Henwood et al. 2015). Best practice dementia care guidelines recommend nonpharmacological interventions, such as physiotherapy and exercise, be the first approach utilised by healthcare practitioners when helping individuals living with dementia manage their symptoms. The Accreditation Standards for Australian RACFs promote independence and exercise, in line with current evidence. In contrast, the Aged Care Funding Instrument (ACFI) focuses on dependency levels of individuals living in RACFs. Although it might be an unintentional outcome, RACFs become financially dependent on assessing the dependency of individuals in their care rather than promoting independence (Chan et al. 2014). None of the ACFI domains include funding for exercise interventions (Australian Physiotherapy Association 2016). Physiotherapy is only considered in a restricted role as part of pain management. The rigid ACFI guidelines impede physiotherapists using their clinical reasoning skills to provide interventions, such as
LIVE BEHIND THE ORANGE DOOR – THE EFFECTS OF CHANGING SUITE DOORS FOR INDIVIDUALS LIVING WITH A DEMENTIA By Alexandria Varshawsky and Victoria Traynor 38 February 2018 Volume 25, No. 7
exercise as part of chronic pain management. Instead, ACFI guidelines prescribe the type and frequency of pain management treatment, unsupported by current evidence (Australian Physiotherapy Association 2012). A recent review of ACFI found it was no longer fit for purpose because it does not reflect a contemporary understanding of the aged care sector, or the characteristics of individuals living in RACFs (McNamee et al. 2017). Evidence supports the use of exercise to maintain function, independence and reduce pain for individuals living with dementia in RACFs. In contrast, ACFI appears focused on assessing dependency levels, rather than assessing care needs which would prevent, maintain or promote the capacity and function of individuals living with dementia in RACFs. More needs to be done to enable RACFs to adopt a reablement model of care which would, inevitably, include a focus on promoting exercise and physiotherapy among individuals living with dementia. To facilitate changes, issues with policies and practices, such as ACFI need to be addressed, or perhaps a new evidence-based funding tool needs to be developed. Dr Lindsey Brett, PhD, Bachelor of Physiotherapy Hons, Registered Physiotherapist, Postdoctoral Research Fellow, Macquarie University Victoria Traynor, PhD, BSc (Nursing Studies) Hons, Professor, University of Wollongong
Dementia friendly designs are important in residential care homes but an aspect that remains neglected is the potential positive role of door designs on individuals living with a dementia. For most individuals living with a dementia, the typical long corridors and repetitive styled doors created in residential care homes cause confusion and frustration. A pilot study in NSW, Australia, tested the effects of unique room door designs for a small group of individuals living with a dementia in a residential care home. Internal doors were transformed using a giant adhesive poster created by a commercial graphic designer. The poster replicated the look of traditional front doors,
References Australian Physiotherapy Association 2012. Position Statement: Supporting Older Australians. Australia. Sydney: Australian Physiotherapy Association. Australian Physiotherapy Association 2016. Aged Care Funding Needs a Change of Tune Sydney: Australian Physiotherapy Association. Brett, L., Stapley, P., Meedya, S. & Traynor, V. 2016a. Effect of Physical Exercise on Physical Performance of Individuals Living with Dementia in Nursing Homes: A Randomized Controlled Trial. University of Wollongong. Brett, L., Traynor, V. & Stapley, P. 2016b. Effects of Physical Exercise on Health and Well-Being of Individuals Living with a Dementia in Nursing Homes: A Systematic Review. Journal of the American Medical Directors Association, 17, 104-116. Brett, L., Traynor, V., Stapley, P. & Meedya, S. 2017. Exercise Interventions for Individuals Living With Dementia in Nursing Homes: Staff and Family Carer Perceptions. Journal of Aging & Physical Activity, [In Press]. Chan, G. Z. P., Chin, C. K. L., Mckitrick, D. J. & Warne, R. W. 2014. Does the Aged Care Funding Instrument Provide Increased Funding in Residential Care? Comparisons With The Residential Classification
Scale.(Report). Australasian Journal on Ageing, 33, 121. Henwood, T., Neville, C., Baguley, C., Clifton, K. & Beattie, E. 2015. Physical and Functional Implications of Aquatic Exercise for Nursing Home Residents with Dementia. Geriatric Nursing, 36, 35-39. Mcnamee, J., Poulos, C., Seraji, H., Kobel, C., Duncan, C., Westera, A., Samsa, P. & Eagar, K. 2017. Alternative Aged Care Assessment, Classification System and Funding Models Final Report. Wollongong: University Of Wollongong: Centre for Health Service Development, Australian Health Services Research Institute. Neville, C., Henwood, T., Beattie, E. & Fielding, E. 2014. Exploring The Effect of Aquatic Exercise on Behaviour and Psychological Well-Being in People with Moderate to Severe Dementia: A Pilot Study of The Watermemories Swimming C Lub. Australasian Journal on Ageing, 33, 124-127.
including a range of bright bold colours and architectural features, such as brass doorknockers, letterboxes and door guards. The well validated Revised Algase Wandering Scale (RAWS) was used to identify the effects of introducing the doors on individuals living with a dementia. A total of nine individuals living with a dementia participated in the project. The post-intervention data demonstrated that there was a reduction in persistent walking (63 to 50%) and eloping behaviours (54 to 43%). In addition, ongoing anecdotal evidence found that participants continued to seek out others to showcase their unique door. The host aged care organisation, Warrigal, extended this project and more residential care homes are transforming their internal room doors for individuals living with a dementia.
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