Function Focused Care in Acute Care: A Philosophy

Abstract

Cognitive deficits in older adults pose significant challenges in all healthcare settings, particularly in acute care hospitals. These challenges often lead to a higher incidence of delirium, extended hospital stays, increased pain, and a decline in functional abilities [1-4]. In this issue of JAGS, Resnick et al. [5] provide evidence that function focused care (FFC) in the acute care hospital (AC) implemented through the Evidence Integration Triangle (EIT) [6] helps prevent functional decline and enhances physical activity in patients living with dementia.

This nurse-led initiative is based on a care philosophy rather than a structured mobility program. The philosophy incorporates elements of the Social Ecological Model, Social Cognitive Theory, and the EIT. A key aspect of this approach is the understanding that self-efficacy and expectations of outcomes influence behavior. The EIT brings together stakeholders including the nurse champions, unit managers, rehabilitation therapists, social workers, quality improvement staff, and a research nurse facilitator. They engaged hospitalized patients with dementia in several ways: by observing others performing the activities, receiving verbal encouragement to participate themselves, and experiencing the positive feelings associated with those activities.

The study is a clustered randomized clinical trial with an intervention consisting of patients who received function focused care by the stakeholder teams. The control group was patients who received education only about function focused care. Both the intervention group (FFC-AC-EIT) and the function-focused education-only group (FFC-EO) demonstrated an increase in function and physical activity over the course of their hospital stay. Notably, these improvements in function and physical activity were sustained in the intervention group in the month after discharge from the hospital compared to the control group. In addition, the patients who received FFC-AC-EIT had less increase in pain, delirium, and neuropsychiatric behaviors during hospitalization compared to the control group. However, these findings were not significantly carried through 1 month after discharge from the hospital, which may be due to the challenges assessing pain, delirium, and dementia-associated behaviors in these patients.

Hospitalization is a sentinel event for a patient living with dementia. It can present with unique challenges, often associated with increased cognitive decline and potential adverse outcomes alongside management of acute illness [1, 2]. Despite the challenges associated with a post Covid healthcare scenario, with differing hospital policies, rates of staff turnover, different types of dementia patients, and coincident multimorbidity, this study provides an anchor for models of Age Friendly Health Systems to provide individualized, comprehensive care to hospitalized patients with dementia focused on maintaining a sustained improvement in function and physical activity during and after an acute inpatient care episode.

Fatima Naqvi reviewed the research paper, contributed in the editorial as an expert. Tahira Lodhi reviewed the research paper, contributed in writing this editorial.

There are no sponsors.

The authors declare no conflicts of interest.

This publication is linked to a related article by Resnick et al. To view this article, visit https://doi.org/10.1111/jgs.19334.