Effects of a controlled exercise trial on pain in nursing home residents

OBJECTIVES: To report preliminary data relevant to the effects of an exercise and toileting intervention on pain among incontinent nursing home (NH) residents. DESIGN: A randomized controlled intervention trial. SETTING AND PARTICIPANTS: Fifty-one incontinent residents in one skilled NH. INTERVENTION: The intervention was implemented by research staff for a total of 4 times a day (every 2 hours), 5 days a week, for 32 weeks. Residents were provided with incontinence care and assistance to either walk or, if nonambulatory, wheel their chairs, and to repeat sit-to-stand movements. MEASUREMENTS: Pain was measured in two ways at baseline and again at 32 weeks: (1) a count of the number of verbal expressions and pain behaviors during a standardized physical performance assessment; and (2) a modified Geriatric Pain Measure administered in a one-on-one interview format. RESULTS: There were significant differences between intervention and control groups on all physical performance measures over time, with the intervention group remaining stable and the control group showing a significant decline in sit-to-stand, walking, and wheelchair propulsion endurance. Both groups showed mild to moderate pain at baseline according to each of the two pain measures, while there were no significant changes in pain reports between groups over time based on either measure. There was, however, a trend for pain to increase in the intervention group. CONCLUSIONS: No significant changes in pain reports were attributable to exercise despite significant improvements in physical performance. In fact, there was a tendency for pain reports to increase with exercise. These preliminary findings suggest that exercise alone may be ineffective for pain management among incontinent NH residents. Care providers should consider that exercise to improve physical function may increase pain symptoms, requiring preemptive analgesia, other pain control strategies, or modified exercise techniques for this frail segment of the NH population.     

A Passive Monitoring System in Assisted Living Facilities: 12-Month Comparative Study

The GE QuietCare? passive monitoring system uses advanced motion sensor technology that learns the daily living patterns of senior community residents and sends alerts when certain out-of-the-ordinary events occur. This study compared falls, hospitalizations, care level changes, and resident attrition between two similar assisted living facilities where one facility adopted the QuietCare? monitoring system and the other did not over a 12-month period. Average falls per week were significantly lower in the QuietCare? facility than the control facility. There was also a trend toward fewer weekly hospitalizations in the QuietCare? facility. There was higher resident retention at the QuietCare? facility. This study provides evidence of direct benefits to both the resident and the facility for the use of QuietCare?. There was a significant reduction in the number of falls, as well as a general facility performance improvement measured by care level consistency and higher resident retention rates.     

The Minimum Data Set bedfast quality indicator: differences among nursing homes

BACKGROUND: Excessive time in bed has negative effects on both physical conditioning and functioning. There are no data or practice guidelines relevant to how nurses should manage the in-bed times of nursing home residents, although all nursing homes receive a bedfast prevalence quality indicator report generated from the Minimum Data Set. OBJECTIVES: To compare nursing homes that score in the upper and lower quartiles on the Minimum Data Set bedfast prevalence quality indicator for proportion of bedfast residents, activity and mobility nursing care, and amount of time all residents spend in bed, and to evaluate whether residents who spend more time in bed are different from those who spend less time in bed according to functional measures. METHODS: A cohort design used medical records, resident interviews, and direct observation data to compare 15 nursing homes (n = 451 residents) on the proportion of bedfast residents, the amount of time residents spent in bed, the frequency of activity, and the scores on six activity and mobility care process indicators. RESULTS: Significant differences were found between upper (i.e., higher prevalence of bedfast residents) and lower quartile nursing homes in the proportion of time residents were observed in bed (43% vs. 34%, respectively; p =.007), and in the proportion of residents who spent more than 22 hours in bed per day (18% vs. 8%, respectively; p =.002). All nursing homes underestimated the number of bedfast residents. The residents of upper quartile homes showed more activity episodes and reported receiving more walking assistance than the residents of lower quartile homes. DISCUSSION: Minimum Data Set bedfast quality indicator identified nursing homes in which residents spent more time in bed, but did not reflect differences in activity and mobility care. In fact, upper quartile homes provided more activity and mobility care than lower quartile homes. Across all the nursing homes, most of the residents spent at least 17 hours a day in bed. Further study of activity and mobility care and bedfast outcomes in nursing homes is needed, and nurses need to note the amount of time nursing home residents spend in bed.     

Effects of 5-Form, Yang Style Tai Chi on older females who have or are at risk for developing osteoporosis

This study investigated the effects of 5-Form, Yang Style Tai Chi (TC) on balance confidence, balance performance, functional strength, mobility, and incidence of falls among individuals with or at risk for developing osteoporosis. This was a pilot outcomes study in which participants served as their own controls. Thirty-one independent, community-dwelling women (mean age of 67.3 years) attended TC sessions twice a week for 12 weeks and practiced at least 1 day a week on their own. A specific TC instruction video was used to facilitate home practice. Baseline, immediate postintervention, and 6 and 12 months postintervention data were recorded. Outcome measures included the Activities-specific Balance Confidence (ABC) Scale, One-Legged Stance Test (OLST) for both legs, Repeated Chair Stands (RCS), and the Timed Up and Go Test (TUG). Exercise performance and falls were tracked during the study by using daily diaries. Balance performance, functional strength, and mobility significantly improved (p < 0.05) immediately postintervention. Most benefits were sustained at 6 months, but only functional strength and mobility remained improved at 12 months postintervention. Most participants reported exercising at the 6- and 12-month follow-up. However, very few individuals continued to practice TC on a regular basis (more than once a week) beyond the 12-week intervention. Balance confidence or incidence of falls did not improve.     

Effects of 5-Form,Yang Style Tai Chi on older females who have or are at risk for developing osteoporosis

This study investigated the effects of 5-Form, Yang Style Tai Chi (TC) on balance confidence, balance performance, functional strength, mobility, and incidence of falls among individuals with or at risk for developing osteoporosis. This was a pilot outcomes study in which participants served as their own controls. Thirty-one independent, community-dwelling women (mean age of 67.3 years) attended TC sessions twice a week for 12 weeks and practiced at least 1 day a week on their own. A specific TC instruction video was used to facilitate home practice. Baseline, immediate postintervention, and 6 and 12 months postintervention data were recorded. Outcome measures included the Activities-specific Balance Confidence (ABC) Scale, One-Legged Stance Test (OLST) for both legs, Repeated Chair Stands (RCS), and the Timed Up and Go Test (TUG). Exercise performance and falls were tracked during the study by using daily diaries. Balance performance, functional strength, and mobility significantly improved (p < 0.05) immediately postintervention. Most benefits were sustained at 6 months, but only functional strength and mobility remained improved at 12 months postintervention. Most participants reported exercising at the 6- and 12-month follow-up. However, very few individuals continued to practice TC on a regular basis (more than once a week) beyond the 12-week intervention. Balance confidence or incidence of falls did not improve.     

Cost per fall: a potentially misleading indicator of burden of disease in health and residential care settings

Rationale Little scrutiny has been applied to how ‘cost per fall’ values have been calculated and applied. This paper presents discourse discussing how the cost of fall statistic could potentially be misleading when applied to inpatient health or residential care settings and provides estimates of the cost of falls and cost of falls per person. Method Burden of disease was estimated using a decision tree approach. Data informing the decision tree were drawn from a retrospective audit of 545 falls in a residential care facility, a visual observation study of 46 residents from the same facility and a cohort study of 186 residents from nine different facilities in Australia. Acute care and transportation costs were extracted from the retrospective audit using incident reports and care note review. The distribution of falls per person and associations between falls, fractures and change in resident mobility were extracted from the cohort study. The association between resident mobility and the amount of time required to perform toileting, transfer and dressing activities was extracted from the visual observational study. Results The minimum ‘cost per fall’ was estimated to be $AUD 841 and the maximum was $AUD 1024. The ‘cost of falls per person’ estimate was $AUD 1887 (2008 base year). Conclusions This cost per fall estimate was substantially lower than three previous internationally derived estimates possibly as a consequence of how fall data were collected and modelled in these studies. Cost of falls per person may be a preferable statistic for future use.     

Changes in physical functioning in institutionalized older adults.

PURPOSE: Chronic care and long-term care facilities have a responsibility to provide care that enables residents to attain or maintain their maximal functional capacity. This paper uses the Minimum Data Set (MDS) to examine changes in functional health. METHODS: One hundred and thirty-eight residents were assessed quarterly using the MDS over a 12 month period in a chronic care and long-term care institution. Physical functioning was conceptualized in two areas of physical limitations (e.g. bed mobility) and disability (e.g. dressing). RESULTS: Ten percent of the residents physical functioning improved. Gender, range of motion score at baseline, change in bed mobility and change in short term memory were strong independent predictors of changes in functional activity FL adjusted R2 = 0.23, F(5156) = 10.47, p<0.0001. The strongest independent predictors of change in ADL were gender, balance while standing at baseline, joint range of motion at baseline and change in depression scores, and weight loss, adjusted R2 = 0.24 , F(4157)= 13.38, p < 0.0001. CONCLUSIONS: Most residents' physical functioning showed a deterioration or remained stable. Impairments which best explained changes in functioning such as range of motion or balance in standing are modifiable and should be targeted in interventions by nursing and rehabilitation staff.     

Balance Exercise Program Reduced Falls in People With Multiple Sclerosis: A Single-Group,Pretest-Posttest Trial

ObjectiveTo evaluate the effects of a balance exercise program on falls in people with mild to moderate multiple sclerosis (MS).DesignMulticenter, single-blinded, single-group, pretest-posttest trial.SettingSeven rehabilitation units within 5 county councils.ParticipantsCommunity-dwelling adults with MS (N=32) able to walk 100m but unable to maintain 30-second tandem stance with arms alongside the body.InterventionSeven weeks of twice-weekly, physiotherapist-led 60-minute sessions of group-based balance exercise targeting core stability, dual tasking, and sensory strategies (CoDuSe).Main Outcome MeasuresPrimary outcomes: number of prospectively reported falls and proportion of participants classified as fallers during 7 preintervention weeks, intervention period, and 7 postintervention weeks. Secondary outcomes: balance performance on the Berg Balance Scale, Four Square Step Test, sit-to-stand test, timed Up and Go test (alone and with cognitive component), and Functional Gait Assessment Scale; perceived limitations in walking on the 12-item MS Walking Scale; and balance confidence on the Activities-specific Balance Confidence Scale rated 7 weeks before intervention, directly after intervention, and 7 weeks later.ResultsNumber of falls (166 to 43; P≤.001) and proportion of fallers (17/32 to 10/32; P≤.039) decreased significantly between the preintervention and postintervention periods. Balance performance improved significantly. No significant differences were detected for perceived limitations in walking, balance confidence, the timed Up and Go test, or sit-to-stand test.ConclusionsThe CoDuSe program reduced falls and proportion of fallers and improved balance performance in people with mild to moderate MS but did not significantly alter perceived limitations in walking and balance confidence.     

Effects of Pilates on the risk of falls,gait, balance and functional mobility in healthy older adults: A randomised controlled trial

ObjectiveTo investigate the effects of Pilates on falls risk, fear of falling, postural balance, functional mobility, spatiotemporal gait parameters, mobility and physical activity in older adults.DesignRandomized Controlled Trial (RCT).MethodsSixty-one older adults, mean age 70.08 (SD = 5.51) were randomly allocated into a Pilates group (PG, n = 29) or control group (CG, n = 32). Intervention comprised a 12-week Pilates program, with exercises performed twice a week and supplementary exercises at home. The Montreal Cognitive Assessment (MOCA), was used to screen cognition. Primary outcomes: Fear of falling, postural balance (force platform), gait velocity (electronic walkway). Secondary outcomes: Functional mobility, mobility, physical activity, and spatiotemporal parameters of gait. Statistical analysis was carried out using Generalized Estimating Equations (GEE). Covariates were adjusted.ResultsPositive effects were found for time effects: Time Up and Go (TUG), anteroposterior (AP) and mediolateral (ML) directions of balance, cadence, (stance, step and double support time). The step and double support time showed significant differences between the two groups (p < 0.05). Interaction between time and groups was found for FRT. Age was a significant factor in TUG, FRT, postural balance for AP under open eyes conditions. Health status was significant for ML in eyes open condition. Gait was significant for age, height and health status.ConclusionEffects of 12 weeks of Pilates intervention on functional mobility, mobility, postural balance and spatiotemporal gait parameters were identified. Further trials of a longer duration are warranted to determine the effectiveness of Pilates on falls prevention.     

Circumstances of Falls During Sit-to-Stand Transfers in Older People: A Cohort Study of Video-Captured Falls in Long-Term Care

ObjectiveTo characterize the circumstances of falls during sit-to-stand transfers in long-term care (LTC), including the frequency, direction, stepping and grasping responses, and injury risk, based on video analysis of real-life falls.DesignCohort study.SettingLTC.ParticipantsWe analyzed video footage of 306 real-life falls by 183 LTC residents that occurred during sit-to-stand transfers, collected from 2007 to 2020. The mean age was 83.7 years (SD=9.0 years), and 93 were female (50.8%).InterventionNot applicable.Main Outcome MeasuresWe used Generalized Estimating Equations to test for differences in the odds that a resident would fall at least once during the rising vs stabilization phases of sit-to-stand and to test the association between the phase of the transfer when the fall occurred (rising vs stabilization) and the following outcomes: (1) the initial fall direction; (2) the occurrence, number, and direction of stepping responses; (3) grasping of environmental supports; and (4) documented injury.ResultsFalls occurred twice as often in the rising phase than in the stabilization phase of the transfer (64.0% and 36.0%, respectively). Falls during rising were more often directed backward, while falls during stabilization were more likely to be sideways (odds ratio [OR]=1.95; 95% confidence interval [CI]=1.07-3.55). Falls during rising were more often accompanied by grasping responses, while falls during stabilization were more likely to elicit stepping responses (grasping: OR=0.30; 95% CI=0.14-0.64; stepping: OR=8.29; 95% CI=4.54-15.11). Injuries were more likely for falls during the stabilization phase than the rising phase of the transfer (OR=1.73; 95% CI=1.04-2.87).ConclusionMost falls during sit-to-stand transfers occurred from imbalance during the rising phase of the transfer. However, falls during the subsequent stabilization phase were more likely to cause injury.     

Provision of rehabilitation nursing in long-term care facilities

AIM: This paper reports an investigation into rehabilitation nursing provided in long-term care settings in Finland, focusing on the amount of time spent with residents, types of rehabilitation nursing provided and resident characteristics associated with rehabilitation nursing. BACKGROUND: In long-term care, nurses have important roles as members of multidisciplinary care teams in the provision of rehabilitation care. Evidence suggests that rehabilitation nursing has a positive impact on maintaining residents' functional performance. However, there is little information on the patterns and scope of rehabilitation nursing in long-term care facilities. METHODS: A quantitative, retrospective and cross-sectional study was designed with the data collected between July and December 2002. Rehabilitation nursing was analysed using the Resident Assessment Instrument used in Finland (n = 5312). The frequency and focus of rehabilitation nursing were presented by mean scores and 95% confidence intervals. Univariate and multivariate logistic regression models were built to describe the factors associated with rehabilitation nursing. Odds ratios and confidence intervals were derived from these models. RESULTS: About 64% of residents received some rehabilitation nursing. Residents assessed as having rehabilitation potential received statistically significantly more rehabilitation nursing than others, such as skills practice in transfer, walking and dressing. Resident factors associated with rehabilitation nursing were cognition, activities of daily living, urinary incontinence, instability of health condition, falls, depression and greater social engagement. CONCLUSION: Specific resident characteristics and nurses' views of rehabilitation potential determine the provision of rehabilitation nursing. This information could be useful in both targeting and planning rehabilitation nursing in long-term care.     

Are your residents safe in their beds?

Of all the issues facing the long term care industry today, perhaps none are more prominent than the two issues of resident falls and bed siderails (restraints). Across the country, care providers are facing the reality of reducing and eliminating patient restraints, including siderails. At the same time, resident falls have also come to the forefront as an extremely important issue; it's now nearly impossible to find a facility without a special Falls Committee focussed on reducing the injuries sustained to residents, often caused when they are transferred or climb out of bed.     

New intervention program for preventing falls among frail elderly people: the effects of perturbed walking exercise using a bilateral separated treadmill

OBJECTIVE: To determine the effects of a perturbed walking exercise using a bilateral separated treadmill in physically disabled elderly. DESIGN: Participants of the study were 32 long-term care facility residents and outpatients aged 66-98 yrs. Participants were randomly assigned to a usual exercise group or to a treadmill exercise group. Perturbed gait exercise on a treadmill continued for 6 mos. Number of falls and time to first fall during a 6-mo period, balance and gait functions, and reaction time were evaluated before and after intervention. RESULTS: The treadmill exercise group showed significant improvement in balance and reaction time when compared with the usual exercise group. Number of falls in the treadmill exercise group was 21% lower than that in the usual exercise group. However, this difference was not significant. No significant differences were seen in time to first fall. CONCLUSIONS: Gait training with unexpected perturbation seems to have a beneficial impact on physical function in disabled elderly individuals. The results suggest that this program may be used as an exercise intervention to reduce falls in institutional settings.     

RN staffing time and outcomes of long-stay nursing home residents: pressure ulcers and other adverse outcomes are less likely as RNs spend more time on direct patient care

OBJECTIVE: A clear link has been demonstrated between lower nurse staffing levels in hospitals and adverse patient outcomes, but the results of studies of such relationships in long-term care facilities haven't been as clear. This study explored the time nurses spent in direct care and how it affected outcomes in long-stay (two weeks or longer) nursing home residents. METHODS: In a retrospective study of data collected as part of the National Pressure Ulcer Long-Term Study (NPULS), we analyzed data on 1,376 residents of 82 long-term care facilities whose lengths of stay were 14 days or longer, who were at risk of developing pressure ulcers but had none at study entry, and who had a Braden Scale score of 17 or less. Primary data came from residents' medical records during 12-week periods in 1996 and 1997. Dependent variables included development of pressure ulcer or urinary tract infection (UTI), weight loss, deterioration in the ability to perform activities of daily living (ADLs), and hospitalization. Independent variables included resident demographics, severity of illness, nutritional and incontinence interventions, medications, and nurse staffing time. RESULTS: More RN direct care time per resident per day (examined in 10-minute increments up to 30 to 40 minutes per resident per day) was associated with fewer pressure ulcers, hospitalizations, and UTIs; less weight loss, catheterization, and deterioration in the ability to perform ADLs; and greater use of oral standard medical nutritional supplements. More certified nursing assistant and licensed practical nurse time was associated with fewer pressure ulcers but did not improve other outcomes. CONCLUSIONS: The researchers controlled for important variables in long-stay nursing home residents at risk for pressure ulcers and found that more RN direct care time per resident per day was strongly associated with better outcomes. There's an urgent need for further research to confirm these findings and, if confirmed, for improving RN staffing in nursing homes to decrease avoidable adverse outcomes and suffering.     

Redesigning nighttime care for personal care residents

This study investigated the effects of non-disruptive nighttime care for residents in a personal care setting. The sample consisted of 18 personal care home residents in an urban, 388-bed, long-term care facility located in Winnipeg, Manitoba, Canada. The study used a quasi-experimental, single-arm design, exposing all residents to both intervention and control conditions. Independent variables were the current nighttime routine of regular rounds to turn and change residents, and a non-disruptive plan of care in which residents were checked hourly by staff and necessary care was provided when they were awake. Outcome variables included total sleep from evening bedtime to morning awakening, longest period of uninterrupted sleep at night, amount of time spent sleeping during the day, self-reported restfulness of cognitively intact residents, and skin condition. Findings suggested that the non-disruptive nighttime care routine increased total sleep by an average of 30 minutes a night for each resident. The amount of uninterrupted sleep increased by approximately 45 minutes with the new routine. No significant differences were noted in the amount of time spent sleeping during the day. There was no evidence of skin breakdown during any phase of the study. Clinical implications of this study demonstrate a need for gerontological nurses to re-evaluate nighttime care routines in personal care settings.     

Incidence of and risk factors for falls following hip fracture in community-dwelling older adults

BACKGROUND AND PURPOSE: Hip fracture is a major medical problem among older adults, leading to impaired balance and gait and loss of functional independence. The purpose of this study was to determine the incidence of and risk factors for falls 6 months following hospital discharge for a fall-related hip fracture in older adults. SUBJECTS: Ninety of 100 community-dwelling older adults (> or =65 years of age) hospitalized for a fall-related hip fracture provided data for this study. METHODS: An observational cohort study used interviews and medical records to obtain information on demographics, prefracture health, falls, and functional status. Self-report of falls and performance-based measures of balance and mobility were completed 6 months after discharge. RESULTS: A total of 53.3% of patients (48/90) reported 1 or more falls in the 6 months after hospitalization. Older adults who fell following discharge had greater declines in independence in activities of daily living and lower performance on balance and mobility measures. Prefracture fall history and use of a gait device predicted postdischarge falls. DISCUSSION AND CONCLUSION: Falls following hip fracture can be predicted by premorbid functional status.     

Task-oriented intervention in chronic stroke: changes in clinical and laboratory measures of balance and mobility

OBJECTIVE: The objective of this study was to evaluate whether, after a task-oriented exercise program, the changes in clinical measures of balance and mobility were paralleled by changes in biomechanical parameters in subjects with chronic stroke. DESIGN: Ten stroke subjects took part in an 8-wk exercise program aimed at improving balance and mobility through various functional tasks. Subjects were evaluated before and after the exercise intervention. Clinical measures included the Berg Balance Scale and the Timed-Up-and-Go and laboratory measures included ground reaction forces and center of pressure displacement during four functional tasks. RESULTS: Stroke subjects showed significant improvements (P < 0.05) in the clinical measures after completing the exercise program. Significant improvements (P < 0.05) were also found in postural steadiness during tandem stance and stool touch and in force production through the paretic lower limb during sit-to-stand. This last result was strongly correlated (r = -0.93) with the improvements on the Timed-Up-and-Go after exercise intervention. In contrast, the increase in postural steadiness was poorly correlated with the improvements on the Berg Balance Scale. CONCLUSIONS: A task-oriented exercise program might improve both clinical and laboratory measures of balance and mobility in stroke subjects. However, several correlations between the changes in clinical and laboratory measures after exercise intervention were generally weak, indicating that these outcome measures assessed different components of improvements.     

Effects of Wii Fit Rehabilitation on Lower Extremity Functional Status in Adults With Severe Burns: A Randomized Controlled Trial

ObjectivesTo investigate the effects of the Wii Fit rehabilitation program in addition to a standard physical therapy program (SPTP) on lower extremity functional status and functional mobility in adults with severe burns after hospital discharge.DesignA single-blinded, parallel groups, randomized controlled trial.SettingsOutpatient rehabilitation center.ParticipantsThirty-four patients (N=34), aged 31.3±7.3 years old, with lower extremity deep partial-thickness and full-thickness burn and total body surface area of more than 40% were allocated randomly into 2 equal groups.InterventionsThe Wii Fit group received the Wii Fit program for 30 minutes in addition to SPTP for 60 minutes, whereas the SPTP group received SPTP only. The intervention was 3 sessions a week for 12 weeks.Main Outcome MeasuresThe primary outcome measurements were the functional status and functional mobility, which were assessed by the high mobility assessment tool, Lower Limb Functional Index, and timed Up and Go test. The secondary outcomes included exercise capacity, muscle strength, and balance measured by the 6-minute walk test, isokinetic muscle strength assessment, and stability index. All the outcome measures were collected at the baseline and after 12 weeks of intervention.ResultsAfter 12 weeks of intervention, there were statistically significant differences between groups in all outcome measures in favor of the Wii Fit group (P<.001). Also, statistically significant differences were found in all the measured outcomes after 12 weeks of intervention in each group (P<.05).ConclusionsPatients with lower extremity burns who received the Wii Fit program in addition to the SPTP had better improvements in lower limb functional status, functional mobility, exercise capacity, muscle strength, and balance than patients who received SPTP alone. The Wii Fit program was a useful adjunctive therapy in rehabilitating adults with lower extremity burn injury.     

Effects of a Relationship-Enhancing Program of Care on Outcomes

Purpose: To examine the effects of a relationship-enhancing program of care (REPC) on resident and care provider outcomes.
Design and Methods: A quasi-experimental, repeated measures design, with intervention and comparison groups. Questionnaires were distributed to 50 residents, and observations were conducted of 40 residents and 34 nursing staff at baseline and 3 months after the intervention, on two Canadian nursing home units. An investigator-designed educational program based on Winnicott's theory of relationships and the empirical literature, was provided to care providers and their supervisors on the intervention unit. Repeated measures analysis of variance (RM-ANOVA) was used to compare the intervention and comparison groups in regard to changes in the outcomes over time.
Findings: The REPC had statistically significant effects on (a) residents' perceptions of care providers' relational care, (b) care providers' relational behaviors, and (c) continuity of care.
Conclusions: Evidence showed that these care providers were taught how to enhance their relational skills with residents living in long-term care facilities without added staff. Recommendations for practice and research are discussed.     

Outcomes of Wheelchair Systems Intervention With Residents of Long-Term Care Facilities

This pilot study was designed to measure the effects of individually prescribed wheelchair systems on posture and reach, mobility, quality of life, and satisfaction with technology for residents of long-term care facilities. Thirty persons 60 years of age or older who resided permanently in a long-term care facility and who used seating and mobility systems for 6 hours or more each day were recruited for this project. Outcomes included timed independent mobility, forward and lateral reach, quality of life, and satisfaction with assistive technology. The study used semicrossover design with participants measured three times. Measurements were first made in the existing seating and mobility system and a second time immediately after participants were provided with individually prescribed seating and mobility systems. The final measurement was 3 months after the delivery of the individually prescribed system. Results indicated that individually fitted wheelchair systems for elderly residents of long-term care facilities are beneficial. Participants had less difficulty independently propelling their systems and increased forward reach, quality of life, and satisfaction with assistive technology. The study used semicrossover design with participants measured three times. Measurements were first made in the existing seating and mobility system and a second time immediately after participants were provided with individually prescribed seating and mobility systems. The final measurement was 3 months after the delivery of the individually prescribed system. Results indicated that individually fitted wheelchair systems for elderly residents of long-term care facilities are beneficial. Participants had less difficulty independently propelling their systems and increased forward reach, quality of life for social function and physical role, and satisfaction with the new wheelchair technology. Persons residing in extended care facilities benefit from receiving individually prescribed wheelchair systems. The individual systems enhance elderly persons' independent mobility, functional reach, feeling of well-being, and satisfaction with their assistive technology.