Longitudinal Comparison of ADL Function Between Green House Nursing Home and Traditional Nursing Home Residents

2.50
Hdl Handle:
http://hdl.handle.net/10755/335550
Category:
Abstract
Type:
Presentation
Title:
Longitudinal Comparison of ADL Function Between Green House Nursing Home and Traditional Nursing Home Residents
Author(s):
Yoon, Ju Young; Bowers, Barbara
Lead Author STTI Affiliation:
Beta Eta-at-Large
Author Details:
Ju Young Yoon, PhD, RN, yoon26@wisc.edu; Barbara Bowers, PhD, RN, FAAN
Abstract:
Session presented on Monday, July 28, 2014: Purpose: In the past few decades, many traditional nursing homes have attempted to transform themselves from hospital-like environments to be more homelike. This model change is generally referred to as a nursing home culture change which includes comprehensive efforts to redesign nursing home environments and transform care delivery to residents. Although care outcomes are significant and ultimate evidence that shows the effects of the new models, research findings about the resident outcomes are still limited and mixed. The purpose of this study is to investigate the effects of a small-scale nursing home model from the longitudinal health outcome trajectories. This study used Green House (GH) homes in the U.S as a representative small-scale nursing home model, and compared the change patterns of activities of daily living (ADLs) over time in GH homes and traditional nursing homes. There were two specific research questions in this study: (1) Does the facility type (whether GH homes or traditional nursing homes) influence the change in ADL function over time? (2) Does the facility type (whether GH homes or traditional nursing homes) predict different patterns of change in ADL function over time? Methods: This study is a retrospective longitudinal analysis using minimum dataset (MDS). The total sample included 95 GH home residents and 146 traditional nursing home residents. The health outcome was measured with ADL function indicating higher scores are more dependent (range: 0 – 40). Growth curve modeling (GCM) was utilized to examine the effect of the facility type on the mean ADL function trajectories between the two groups controlling for age, comorbidity score, cognitive function and depressive symptoms. Growth mixture model (GMM) was employed to identify different patterns of change in ADL function over time and examine the effect of facility type on predicting different patterns of change in ADL over time. After deciding the latent classes (number = 2 in this study), the logistic regression was applied to examine the effect of facility type to predict the class membership controlling for age, comorbidity score, cognitive function and depressive symptoms. Results: Major study findings are: (1) the ADL function of both groups were reported to become worse over time (slope = 0.56, p=0.017), but no statistically significant differences of the overall pattern of change in ADL function over time between the two groups controlling for age, comorbidity score, cognitive function and depressive symptoms at baseline. (2) Two different patterns of change in ADL function were identified using GMM including persistent independent group (n=41, intercept = 8.34 [p = 0.049], slope = -0.78 [p = 0.199]) and persistent dependent group (n=200, intercept = 19.70 [p = 0.000], slope = 0.61 [p = 0.823]). Again, higher ADL scores were more dependent status. After controlling age, comorbidity score, cognitive function and depressive symptoms at baseline, the facility type factor staying in the GH homes did not predict the resident’s likelihood of being in the persistent independent group than being the persistent dependent group at the statistical level (Odds ratio = 1.19, 95% Confidence interval = [0.58, 2.46]). Conclusion: As a conclusion, the changes in ADL function over time were not different between the two types of nursing home residents whether in GH homes or traditional nursing homes. The essential elements of small-scale nursing homes include private rooms and bathrooms in a small-scale unit, and encouraging independence for residents, so a physical environment that inspires self-care in private areas is generally expected to improve ADL function in small-scale nursing homes. Furthermore, GH nursing homes philosophically emphasize communal eating in the dining area like a family and self-care in their private rooms and bath-rooms, which may encourage mobility or walking with or without assistance compared to other types of nursing homes. However, while there are positive aspects to private rooms, isolation has been identified as a potential problem in the GH nursing home model because many residents who are not cognitively intact spend more of their time in their rooms. In addition, the limited involvement in structured activities may lead nursing home residents to not have many opportunities to improve or maintain physical or ADL functions in small-scale nursing homes. Thus, further replication studies to examine the effectiveness of small-scale nursing home models using larger number of sample size are necessary. In addition, as concrete strategies of care processes are important to provide practical information to improve residents’ functional status, the kinds of care processes that may influence the maintenance or improvement of ADL function of nursing home residents need to be explored together in the future.
Keywords:
Health outcome; Culture change nursing homes; Longitudinal analysis
Repository Posting Date:
17-Nov-2014
Date of Publication:
17-Nov-2014
Conference Date:
2014
Conference Name:
25th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International, the Honor Society of Nursing
Conference Location:
Hong Kong
Description:
International Nursing Research Congress, 2014 Theme: Engaging Colleagues: Improving Global Health Outcomes. Held at the Hong Kong Convention and Exhibition Centre, Wanchai, Hong Kong
Note:
This is an abstract-only submission. If the author has submitted a full-text item related to this abstract, you may find it by browsing the repository by author. If author contact information is availabe in this abstract, please feel free to contact him or her with your queries regarding this submission.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleLongitudinal Comparison of ADL Function Between Green House Nursing Home and Traditional Nursing Home Residentsen_GB
dc.contributor.authorYoon, Ju Youngen_GB
dc.contributor.authorBowers, Barbaraen_GB
dc.contributor.departmentBeta Eta-at-Largeen_GB
dc.author.detailsJu Young Yoon, PhD, RN, yoon26@wisc.edu; Barbara Bowers, PhD, RN, FAANen_GB
dc.identifier.urihttp://hdl.handle.net/10755/335550-
dc.description.abstractSession presented on Monday, July 28, 2014: Purpose: In the past few decades, many traditional nursing homes have attempted to transform themselves from hospital-like environments to be more homelike. This model change is generally referred to as a nursing home culture change which includes comprehensive efforts to redesign nursing home environments and transform care delivery to residents. Although care outcomes are significant and ultimate evidence that shows the effects of the new models, research findings about the resident outcomes are still limited and mixed. The purpose of this study is to investigate the effects of a small-scale nursing home model from the longitudinal health outcome trajectories. This study used Green House (GH) homes in the U.S as a representative small-scale nursing home model, and compared the change patterns of activities of daily living (ADLs) over time in GH homes and traditional nursing homes. There were two specific research questions in this study: (1) Does the facility type (whether GH homes or traditional nursing homes) influence the change in ADL function over time? (2) Does the facility type (whether GH homes or traditional nursing homes) predict different patterns of change in ADL function over time? Methods: This study is a retrospective longitudinal analysis using minimum dataset (MDS). The total sample included 95 GH home residents and 146 traditional nursing home residents. The health outcome was measured with ADL function indicating higher scores are more dependent (range: 0 – 40). Growth curve modeling (GCM) was utilized to examine the effect of the facility type on the mean ADL function trajectories between the two groups controlling for age, comorbidity score, cognitive function and depressive symptoms. Growth mixture model (GMM) was employed to identify different patterns of change in ADL function over time and examine the effect of facility type on predicting different patterns of change in ADL over time. After deciding the latent classes (number = 2 in this study), the logistic regression was applied to examine the effect of facility type to predict the class membership controlling for age, comorbidity score, cognitive function and depressive symptoms. Results: Major study findings are: (1) the ADL function of both groups were reported to become worse over time (slope = 0.56, p=0.017), but no statistically significant differences of the overall pattern of change in ADL function over time between the two groups controlling for age, comorbidity score, cognitive function and depressive symptoms at baseline. (2) Two different patterns of change in ADL function were identified using GMM including persistent independent group (n=41, intercept = 8.34 [p = 0.049], slope = -0.78 [p = 0.199]) and persistent dependent group (n=200, intercept = 19.70 [p = 0.000], slope = 0.61 [p = 0.823]). Again, higher ADL scores were more dependent status. After controlling age, comorbidity score, cognitive function and depressive symptoms at baseline, the facility type factor staying in the GH homes did not predict the resident’s likelihood of being in the persistent independent group than being the persistent dependent group at the statistical level (Odds ratio = 1.19, 95% Confidence interval = [0.58, 2.46]). Conclusion: As a conclusion, the changes in ADL function over time were not different between the two types of nursing home residents whether in GH homes or traditional nursing homes. The essential elements of small-scale nursing homes include private rooms and bathrooms in a small-scale unit, and encouraging independence for residents, so a physical environment that inspires self-care in private areas is generally expected to improve ADL function in small-scale nursing homes. Furthermore, GH nursing homes philosophically emphasize communal eating in the dining area like a family and self-care in their private rooms and bath-rooms, which may encourage mobility or walking with or without assistance compared to other types of nursing homes. However, while there are positive aspects to private rooms, isolation has been identified as a potential problem in the GH nursing home model because many residents who are not cognitively intact spend more of their time in their rooms. In addition, the limited involvement in structured activities may lead nursing home residents to not have many opportunities to improve or maintain physical or ADL functions in small-scale nursing homes. Thus, further replication studies to examine the effectiveness of small-scale nursing home models using larger number of sample size are necessary. In addition, as concrete strategies of care processes are important to provide practical information to improve residents’ functional status, the kinds of care processes that may influence the maintenance or improvement of ADL function of nursing home residents need to be explored together in the future.en_GB
dc.subjectHealth outcomeen_GB
dc.subjectCulture change nursing homesen_GB
dc.subjectLongitudinal analysisen_GB
dc.date.available2014-11-17T13:54:46Z-
dc.date.issued2014-11-17-
dc.date.accessioned2014-11-17T13:54:46Z-
dc.conference.date2014en_GB
dc.conference.name25th International Nursing Research Congressen_GB
dc.conference.hostSigma Theta Tau International, the Honor Society of Nursingen_GB
dc.conference.locationHong Kongen_GB
dc.descriptionInternational Nursing Research Congress, 2014 Theme: Engaging Colleagues: Improving Global Health Outcomes. Held at the Hong Kong Convention and Exhibition Centre, Wanchai, Hong Kongen_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item related to this abstract, you may find it by browsing the repository by author. If author contact information is availabe in this abstract, please feel free to contact him or her with your queries regarding this submission.en_GB
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