Annals of Long Term Care

Over one-third of long-term care (LTC) residents exhibit moderate-to-severe cognitive impairment. These residents are more likely to be inactive, require assistance with activities of daily living, have medical comorbidities, and be exposed to fewer opportunities to engage in functional and physical activities than peers who are cognitively intact or have only mild cognitive deficits. This article will discuss factors that influence the functional performance of older adults with dementia, and benefits and barriers to implementing a function-focused philosophy of care for LTC residents with dementia. Specific strategies for implementation of function-focused care with this population will be described using a social ecological framework. (Annals of Long-Term Care: Clinical Care and Aging 2010;18[6]:27-32)

Alzheimer’s disease (AD) and other related dementia syndromes present a significant public health problem for the aging population in the United States.¹ Given the progressive deterioration in cognitive and functional abilities associated with the majority of dementia syndromes, it is estimated that by the year 2020, more than 3 million older adults with moderate-to-severe cognitive impairment will require nursing home (NH) care.^2-4 Even without the impact of acute illness, significant decline in functional abilities, including bed mobility, transfer, locomotion, dressing, eating, toileting, and personal hygiene, occurs within six months among NH residents with moderate and severe cognitive impairment.⁵

Factors That Influence Functional Performance in Older Adults with Dementia
Physical function of older adults with dementia is affected by a variety of factors such as age, gender, dementia severity, comorbid illness, mood, the care environment, and interpersonal relationships.^6,7 Long-term care (LTC) staff can help to maintain or temporarily improve the physical function and physical activity of residents with dementia by motivating them to actively participate in care activities and providing them with environments that support an active lifestyle.

Unfortunately, the care of LTC residents with dementia has traditionally followed a custodial approach where staff performs necessary functional tasks for these residents regardless of resident abilities and focuses on minimizing behavioral problems during care activities.^8,9 This rapid decline in functional abilities has serious implications for the amount of care needed, the increasing health risks associated with decreased mobility, the cost of providing care, and the quality of life for LTC residents with dementia.^1,10,11 While we anticipate the development of interventions to more effectively treat or postpone the onset of dementia, it is important for the LTC treatment team to utilize currently available interventions that optimize or temporarily maintain functional abilities and quality of life for LTC residents with dementia.^12,13

Function-Focused Care
Function-focused care is a philosophy of care that is designed to prevent or minimize functional decline and restore LTC residents to their optimal functional abilities.^7,14-16 It incorporates behavior change strategies for both residents and LTC staff so that care practices move beyond the custodial management of clinical problems by getting care tasks completed to one that focuses on actively engaging residents in functional tasks and physical activity.¹⁷ A function-focused philosophy of care promotes the belief that all residents are capable of and benefit from some improvement or maintenance of functional potential, even though the function may not be entirely independent, such as passive range of motion through hand-over-hand feeding, or locomotion through self-propulsion in a wheelchair.