Nursing rehabilitation and exercise strategies in the nursing home.
BACKGROUND
The purpose of this study was to evaluate how weight training or nursing-based rehabilitative care programs in nursing homes impact on resident performance of Activities of Daily Living (ADL) and objectives tests of physical performance.


METHODS
This study involved a quasi-experimental control, longitudinal comparison of functional status over a 10-month period, where baseline status was adjusted through a weighting procedure based on functional status, cognitive status, and age. All residents from six residential care nursing home facilities were eligible except those with a terminal prognosis, a projected stay of less than 90 days, or with health complications that prohibited contact. Homes were placed into matched triplets based on patient characteristics: two members of each triplet were randomly designated to be experimental sites, the third became the control site. Baseline data were available for 468 subjects, follow-up for 392. ADL self-performance measures derived from the Minimum Data Set, including indicators of early loss ADL, locomotion, and late loss ADL; a number of objective functional tests (including measures of balance, power, and endurance); and mood state as measured by the Geriatric Depression Scale.


RESULTS
Mean ADL values in the two experimental groups declined at a significantly lower rate than did rates for the controls. Functional decline was also lower in more specific measures: locomotion, early loss ADL, and late loss ADL.


CONCLUSIONS
With both interventions, facilities were able to implement a broad-based intervention that resulted in a significant reduction in ADL decline rates. A facility-wide nursing rehabilitation program can play a useful role in reversing functional decline, helping residents to maintain their involvement in a broad spectrum of ADL activities.
Morris
J N
JN
The Hebrew Rehabilitation Center for Aged Research and Training Institute, Boston, Massachusetts 02131, USA. jnm@thor.hrca.harvard.edu
Fiatarone
M
M
Kiely
D K
DK
Belleville-Taylor
P
P
Murphy
K
K
Littlehale
S
S
Ooi
W L
WL
O'Neill
E
E
Doyle
N
N
D000203:Activities of Daily Living; D000368:Aged; D005081:Exercise Therapy; D015577:Geriatric Assessment; D006707:Homes for the Aged; D006801:Humans; D009735:Nursing Homes; D019145:Rehabilitation Nursing