The Value of the Evidence Integration Triangle

Abstract The Evidence Integration Triangle involved engaging stakeholders in the 12 month FFC-AL-EIT activities including identifying community specific goals, supporting the staff implementing the intervention, and intervening when champions or staff were not engaged in intervention activities. Ongoing participation of the stakeholder team occurred through monthly meetings. Evaluation of implementation was based on the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) Model. Reach was based on 85 of 90 communities participating and 794 residents recruited. Effectiveness was supported based on less functional decline and more function focused care performed by residents. Adoption was based on evidence that monthly meetings were held, 77% of settings engaged as, or more than expected, and caregivers increased the amount of function focused care provided. The intervention was implemented as intended, knowledge was received, and environments and policies supporting function focused care were maintained. The Evidence Integration Triangle is an effective implementation approach for assisted living.

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Factors Leading to Institutionalization among the Oldest Old: Longitudinal Findings from the AgeCoDe-AgeQualiDe Study

Gerontology ◽

10.1159/000519709 ◽

2021 ◽

pp. 1-9

Author(s):

André Hajek ◽

Elżbieta Buczak-Stec ◽

Hendrik van den Bussche ◽

Marion Eisele ◽

Anke Oey ◽

...

Keyword(s):

Depressive Symptoms ◽

Assisted Living ◽

Service Use ◽

Oldest Old ◽

Strong Association ◽

Functional Decline ◽

Term Care ◽

Random Effects Models ◽

Related Quality ◽

Health Related

Introduction: Due to the strong association between old age and the need for long-term care, the number of individuals in need for care is projected to increase noticeably. The aim of this study was to examine the determinants of institutionalization among the oldest old longitudinally. Methods: Longitudinal data (follow-up [FU] wave 7–9) were gathered from a multicenter prospective cohort study (“Study on needs, health service use, costs and health-related quality of life in a large sample of oldest old primary care patients [85+],” AgeQualiDe). At FU wave 7, in 2014, complete measures were available for 763 individuals. The average age was 88.9 (standard deviation 2.9) years (range 85–100), and 68% were female. Sociodemographic and health-related independent variables (e.g., depressive symptoms or functioning) were included in the regression model. Institutionalization (admission to assisted living home or nursing home) was used as an outcome measure. Logistic random-effects models were used. Results: Regressions revealed that among oldest old, the odds of being institutionalized were lower for men (odds ratio [OR] = 0.03; 95% confidence interval [CI] 0.00–0.16). Institutionalization was associated with an increased age (OR = 1.27; 95% CI 1.04–1.55). Additionally, widowed individuals (ref. non-widowed) had higher odds of being institutionalized (OR = 8.95; 95% CI 1.61–49.81). Institutionalization was also associated with functional decline (OR = 0.16; 95% CI 0.11–0.23), whereas it was not significantly associated with cognitive decline, depressive symptoms, and social support. Conclusion: Our findings stress the importance of gender, age, widowhood, and functional decline for institutionalization among the oldest old. Preventing or at least postponing functional decline might help to delay institutionalization as far as possible.

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P083: Why do older adults in assisted living facilities use the emergency department: are all these visits necessary?

CJEM ◽

10.1017/cem.2016.259 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S106-S106

Author(s):

E. Losier ◽

A. McCollum ◽

P. Jarrett ◽

R. McCloskey ◽

P. Nicholson ◽

...

Keyword(s):

Emergency Department ◽

Assisted Living ◽

Demographic Data ◽

Care Home ◽

Functional Decline ◽

Retrospective Chart Review ◽

Community Services ◽

Level 3 ◽

Ed Visits ◽

One Year

Introduction: Special Care Home (SCH) residents require supervision for activities of daily living but not regular nursing care. Emergency Department (ED) use by seniors in SCHs is poorly studied. A recent study in Nova Scotia found seniors represented over 20% of ED visits. We studied SCH resident ED visits in a community with a population of 30,000 aged over 65 years and with 785 SCH beds, to define reasons for ED visits to a tertiary ED, and if these could be avoided. Methods: We performed a retrospective chart review of SCH residents’ visits to an ED (SCH-ED) which has 56,000 total ED (TED) visits over one year. Reasons for visit, admission data, and avoidability were collected. A geriatrician and ED physician independently reviewed visits. Initial disagreement on avoidability (27%) was adjudicated through case discussion. Results: Demographic data revealed 344 ED visits by 111 SCH residents over one year; 37% of visits resulted in admission. 13.9% of residents visited the ED on at least one occasion (average 3.1 visits); mean age 78.4 years; female 66.7%; ambulance arrival 91.0%. The three most common chief complaints were shortness of breath, weakness and abdominal pain. Most SCH-ED visits were Canadian Triage and Acuity Scale (CTAS) Level 3 (63.4%, TED 53.3%). Of CTAS Level 3 visits, 35.3% were admitted (TED 12.9%). SCH-ED visits were avoidable in 40.6% of cases. Gastrointestinal (18%), pain (16.5%), falls, functional decline or injury (14%) and respiratory (12%) were the most common avoidable diagnostic groups, accounting for 57% of total SCH visits. Conclusion: ED visits by SCH residents demonstrated increased acuity and admission rates with a high number of repeat visits. Of all SCH-ED visits, 40% were potentially avoidable. Further study may determine if improved community services reduces ED visits or hospital admission. Gastrointestinal, respiratory, falls and pain diagnoses may be important areas of focus.

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Rehabilitation Outcomes in Subjects with West Nile Neuro-Invasive Disease

Brain Sciences ◽

10.3390/brainsci11101253 ◽

2021 ◽

Vol 11 (10) ◽

pp. 1253

Author(s):

Komal Patel ◽

Brian D. Greenwald ◽

Rosanna C. Sabini

Keyword(s):

Brain Injury ◽

Assisted Living ◽

Functional Decline ◽

Skilled Nursing Facility ◽

Functional Independence Measure ◽

Inpatient Rehabilitation ◽

The United States ◽

Functional Independence ◽

West Nile ◽

Rehabilitation Facility

West Nile Virus (WNV) is the most common mosquito borne cause of viral encephalitis in the United States. Physical and neuro-cognitive recovery from WNND may be prolonged or incomplete leading to chronic cognitive inefficiencies and functional decline. There continues to be no effective treatment of WNV and current management is primarily supportive. The objective of this review is to evaluate the functional outcomes and role of rehabilitation services in subjects with WNND. The charts of five subjects admitted to an acute inpatient brain injury rehabilitation facility from June to December 2012 were retrospectively reviewed. (Mean, Range)-Age (64.8, 43–78 years), Admission Functional Independence Measure (FIM) (45.2, 14–63), Discharge FIM (82.2, 61–100), FIM score gain (37, 24–60), Cognitive FIM gain (7, 1–18), Mobility FIM gain (17.4, 13–20), ADL FIM gain (12.6, 4–23); acute brain injury inpatient rehabilitation facility length of stay (LOS) (17.8, 14–21 days); acute hospital LOS (15, 10–22 days). Of the five subjects, three were discharged home, one was discharged to a skilled nursing facility, and one was discharged to an assisted living facility. Subjects with WNND have significant functional decline across all FIM subcategories and may benefit from a course of brain injury-specific acute inpatient rehabilitation.

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The Impact of Cognitive impairment on Clinical Symptoms, Physical Activity and Care Interactions among Residents in Assisted Living Settings

Clinical Nursing Research ◽

10.1177/10547738211040628 ◽

2021 ◽

pp. 105477382110406

Author(s):

Barbara Resnick ◽

Marie Boltz ◽

Elizabeth Galik ◽

Shijun Zhu

Keyword(s):

Physical Activity ◽

Cognitive Impairment ◽

Assisted Living ◽

Clinical Symptoms ◽

Secondary Data ◽

Ongoing Trial ◽

Trial Testing ◽

The Impact ◽

Evidence Integration

The purpose of this study was to describe differences in pain, behavioral symptoms, quality of staff-resident interactions, participation in function focused care and physical activity among residents with and without cognitive impairment in assisted living. This was a secondary data analysis using baseline data from an ongoing trial testing Function Focused Care for Assisted Living using the Evidence Integration Triangle (FFC-AL-EIT). A total of 550 residents were recruited from 59 communities. The average age of participants was 89.30 ( SD = 7.63), the majority were white (98%), female (69%), had evidence of cognitive impairment (75%), and 5.16 ( SD = 1.86) comorbidities. Those with cognitive impairment had more pain, were more sedentary and less likely to engage in function focused care activities. Addressing pain and implementing interventions for those with cognitive impairment to participate in function focused care may help optimize function and physical activity in assisted living residents.

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Developing an Intervention to Reduce Sedentary Behavior: Assisted Living Resident Feedback

Innovation in Aging ◽

10.1093/geroni/igaa057.1227 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 381-381

Author(s):

Katelyn Webster ◽

Janet Larson

Keyword(s):

Sedentary Behavior ◽

Thematic Analysis ◽

Assisted Living ◽

Functional Decline ◽

Functional Abilities ◽

Structured Interviews ◽

Light Physical Activity ◽

Wide Range ◽

Intervention Message ◽

Short Intervention

Abstract Older adults in assisted living (AL) tend to be highly sedentary, which increases their risk of functional decline and frailty. Reducing sedentary behavior (SB) and replacing it with light physical activity (LPA) could have important implications for maintenance of functional abilities. The purpose of this qualitative study was to gather feedback from AL residents on a proposed exercise-specific self-efficacy enhancing intervention designed to promote LPA and reduce SB. We conducted one-on-one semi-structured interviews at four AL facilities with 20 residents ages 65-99 (mean age 83.1; 60% women). They were presented with the proposed intervention and were asked questions to inform the development and modification of the intervention. Data were analyzed with a thematic analysis approach. Specific recommendations included short intervention sessions of one hour and scheduled in the morning. Many residents thought a 16 week intervention was too long. We identified broader themes, including concerns about how the intervention would work for residents with a wide range of abilities and concerns about safety. They suggested that exercises will need to be highly modifiable. Most residents recommended framing the intervention message as increasing LPA rather than decreasing SB, because it would be more positive. All except one said they would want to participate in the intervention, but they were unsure how many other residents would want to be more active. The resident feedback and suggestions will guide development of the intervention and are important for increasing the probability that a future feasibility and acceptability trial of the intervention will be successful.

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Reliability and Validity of the Checklist for Function-Focused Care in Service Plans

Clinical Nursing Research ◽

10.1177/1054773818783178 ◽

2018 ◽

Vol 29 (1) ◽

pp. 21-30 ◽

Cited By ~ 1

Author(s):

Barbara Resnick ◽

Elizabeth Galik ◽

Marie Boltz ◽

Sarah Holmes ◽

Steven Fix ◽

...

Keyword(s):

Assisted Living ◽

Interrater Reliability ◽

Rasch Analysis ◽

Reliability And Validity ◽

White Female ◽

Dissemination And Implementation ◽

Assisted Living Facilities ◽

Alpha Coefficient ◽

Care Approach ◽

Evidence Integration

The purpose of this study was to test the reliability and validity of the Checklist for Function-Focused Care in Service Plans. Function-focused care is a care approach that optimizes function and physical activity during all care interactions. This study used baseline data from the first cohort of the study titled Dissemination and Implementation of Function-Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT). A total of 242 participants were recruited from 26 assisted living facilities. The majority of participants were White, female, and unmarried. There was support for internal consistency with an alpha coefficient of .96, interrater reliability with a correlation of .80, construct validity based on Rasch analysis and INFIT statistics ranging from 0.69 to 1.29, and a significant association with function-focused care activities. Although there is some support for reliability and validity of the measure, modifications are recommended to add more challenging items.

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CITIZENSHIP EDUCATION IN EFL TEXTBOOKS SECONDARY LEVEL: A CONTENT ANALYSIS

The International Journal of Applied Language Studies and Culture ◽

10.34301/alsc.v2i2.19 ◽

2019 ◽

Vol 2 (2) ◽

pp. 5-10

Author(s):

Fatima Zohra KROUM

Keyword(s):

Content Analysis ◽

Lifelong Learning ◽

Civic Education ◽

Citizenship Education ◽

Secondary Level ◽

Future Generations ◽

Policy Makers ◽

Good Citizen ◽

Effective Implementation ◽

Implementation Approach

In order to build a good and secure society, people should believe in civic engagement and participation. Citizenship education should begin at a very young age and continue into adulthood as a process of lifelong learning. Hence, the present paper aims at examining the extent to which EFL textbooks at secondary level are civically oriented using a descriptive content analysis. It is also meant to identify how the concept of the “good citizen” is implemented through course units of the textbook. The paper will draw important implications for syllabus designers, and teachers. Policy makers are also required to incorporate an effective implementation approach of civic education in Moroccan National textbooks so that future generations will be aware of their rights, responsibilities and their full commitment toward the community at large.

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Feasibility, Reliability, and Validity of the MotionWatch 8 to Evaluate Physical Activity Among Older Adults With and Without Cognitive Impairment in Assisted Living Settings

Journal of Aging and Physical Activity ◽

10.1123/japa.2020-0198 ◽

2020 ◽

pp. 1-9

Author(s):

Barbara Resnick ◽

Marie Boltz ◽

Elizabeth Galik ◽

Steven Fix ◽

Shijun Zhu

Keyword(s):

Physical Activity ◽

Older Adults ◽

Cognitive Impairment ◽

Hypothesis Testing ◽

Assisted Living ◽

Reliability And Validity ◽

Dissemination And Implementation ◽

And Function ◽

Evidence Integration

This study tested the feasibility, reliability, and validity of the MotionWatch 8 among assisted living residents with and without cognitive impairment. Data from the Dissemination and Implementation of Function Focused Care in Assisted Living Using the Evidence Integration Triangle study were used. The sample included 781 individuals from 85 facilities with a mean age of 89.48 (SD = 7.43) years. The majority were female (71%), White (97%), and overall (44%) had cognitive impairment. A total of 70% were willing to wear the MotionWatch 8. Reliability was supported as there was no difference in time spent in activity across three consecutive wear days. Validity was based on hypothesis testing, and function was associated with counts of activity at baseline (p = .001) and 4 months (p = .001). Those with cognitive impairment engaged in less physical activity (p = .04). The MotionWatch 8 is a useful option for measuring physical activity in older adults with and without cognitive impairment.

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Model Testing of the Factors That Influence Performance of Function Focused Care and Function Among Assisted Living Residents

Journal of Applied Gerontology ◽

10.1177/0733464820976435 ◽

2020 ◽

pp. 073346482097643

Author(s):

Barbara Resnick ◽

Marie Boltz ◽

Elizabeth Galik ◽

Steven Fix ◽

Sarah Holmes ◽

...

Keyword(s):

Assisted Living ◽

Secondary Data ◽

Model Testing ◽

Dissemination And Implementation ◽

Factors Associated ◽

Profit Status ◽

Using Data ◽

And Function ◽

Evidence Integration

The purpose of this study was to test a model of factors associated with participating in function focused care. Function focused care is a philosophy of care in which residents are encouraged to engage in functional and physical activities during care interactions. This was a secondary data analysis using data from the Dissemination and Implementation of Function Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT) study. Residents ( n = 550) were recruited from 59 AL settings. The majority were female ( n = 380, 69%) and White ( n = 536, 97%). Model testing was done. Comorbidities, quality of interactions, environments, profit status, cognitive impairment, depression, and function were associated with function focused care and accounted for 17% of the variance. Next steps should include intervening on changeable factors (e.g., environments) and adding factors to better explain performance of function focused care such as motivation, resilience, and staff satisfaction.

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The Impact of Physical Activity and Function on Falls in Assisted Living Residents

Journal of Aging and Physical Activity ◽

10.1123/japa.2018-0291 ◽

2019 ◽

Vol 27 (6) ◽

pp. 816-822 ◽

Cited By ~ 1

Author(s):

Barbara Resnick ◽

Elizabeth Galik ◽

Marie Boltz ◽

Erin Vigne ◽

Sarah Holmes ◽

...

Keyword(s):

Physical Activity ◽

Older Adults ◽

Assisted Living ◽

Baseline Data ◽

Moderate Physical Activity ◽

Vigorous Activity ◽

Wald Statistic ◽

And Function ◽

The Impact ◽

Evidence Integration

The purpose of this study was to describe physical activity and function of older adults in assisted living communities and test the association between moderate and vigorous activity and falls. This study used baseline data from 393 participants from the first two cohorts in the Function-Focused Care in Assisted Living Using the Evidence Integration Triangle study. The majority of participants were female (N = 276, 70%) and White (N = 383, 97%) with a mean age of 87 years (SD = 7). Controlling for age, cognition, gender, setting, and function, the time spent in moderate or vigorous levels of physical activity was associated with having a fall in the prior 4 months. Those who engaged in more moderate physical activity were 0.6% less likely to have a fall (OR = 0.994, Wald statistic = 5.54, p = .02), and those who engaged in more vigorous activity were 2% less likely to have a fall (OR = 0.980, Wald statistic = 3.88, p = .05).

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