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A behavioural approach to the maintenance and rehabilitation of independent functioning with the institutionalized elderly

University of British Columbia

Rehabilitation programs for the institutionalized elderly have often proved unsuccessful. Recent behavioural research provides some tentative answers concerning the components needed for a successful program. A basic problem, however, is the generalization of these behaviourally based programs to the natural environment. This study focused on the development and evaluation of a program (CARE) which encouraged the maintenance and rehabilitation of various activities of daily living (ADL) while becoming a regular and permanent part of the institutional life of the patient. Two facilities served as the settings for the study. These facilities were architecturally identical as were the staffing patterns and patient characteristics. Facility A was randomly chosen as the experimental facility and contained 127 residents 60 years of age and older (39 male, 88 female) with a mean age of 82 years. Facility B, the control facility, housed 130 residents 60 years of age and older (47 male, 83 female) with a mean age of 79 years. No significant differences were found between the two facilities on sex, primary diagnosis, length of stay or degree of confusion. However, Facility A subjects were significantly older (p<.01) and more ambulatory (p<.03) than those subjects in Facility B. All subjects were assessed on four measures evaluating various activities of daily living (dressing, grooming, eating and ambulation/transfer skills) as well as a: global measure of these activities (global ADL). Assessments were conducted at parallel points in time, just prior to the beginning of treatment in Facility A and after 3 and 6 months. Facility B received no special treatment. Facility A received a treatment program which consisted of: 1) staff training in basic rehabilitation and behaviour change techniques; 2) a treatment manual outlining specific steps in rehabilitation and behaviour change with various activities of daily living; and 3) a visual chart used to communicate data as well as treatment goals. Inter-rater reliability measures were obtained and were above .89 on all dependent measures over the three assessment periods. During the course of the study 15 subjects were lost from Facility A and 22 subjects from Facility B due to death or transfer to more intensive care. These subjects were not included in the data analyses. No significant pre-treatment differences were found on any of the dependent measures other than ambulation/ transfer skills. Two subgroups were formed and analyzed separately for this measure - ambulatory subjects (Facility A, n=100; Facility B, n=78) and wheelchair subjects (Facility A, n=12; Facility B, n=30). Repeated measures analyses of variance yielded significant 'facility' effects for global ADL, dressing and grooming skills (all p<.04), as well as significant 'facility by time' interaction effects for global ADL, dressing and grooming skills (p<.001) and ambulation/transfer skills for wheelchair subjects (p<.04). Tukey tests indicated that, although there were no significant differences within either facility over time, there were significant differences in favour of Facility A for global ADL and grooming skills at the 3 month assessment and in global ADL, grooming and dressing skills at the 6 month assessment (all p<.05). The results demonstrated that this program is a feasible and potentially effective treatment approach and methodology. Increased maintenance and rehabilitation was achieved under circumstances that limited the potential impact of the program. These results are discussed in terms of the limitations of the study and future directions for research.

Text

2010-03-04

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http://hdl.handle.net/2429/21506

Psychology

University of British Columbia

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