Veterans are admitted to Veterans Health Administration (VA) Nursing Homes (NH) because impairment in their ability to perform activities of daily living (ADL) overwhelms their support system (family/friends) in the community. The etiologies of this impairment are, in part, due to chronic disease, deconditioning, and immobility. Yet, after admission, NH residents frequently have decreased levels of daily activity compared with their preadmission activity. Our preliminary observations suggest that dependent, frail residents improve in function in response to exercise in a NH setting.
By comparing an exercise group with a non-exercise group that receives a comparable level of staff attention and positive reinforcement, we will determine whether changes in function normally associated with low intensity exercise are due to exercise or to other factors.
We conducted a blinded, prospective, randomized, controlled, clinical investigation at a VA nursing home, comparing the effect of four months of low intensity exercise with the effect of music and art activity on: 1) muscle mass, assessed by DEXA scan; 2) physical function, assessed by timed performance tests, strength and independence in ADL; and 3) the cost of NH care, assessed by measuring the cost of providing care within the NH minus the cost of providing the intervention. Study setting is a VA nursing home, resident participants are new admissions to the NH and are 65 years or older. All participants must be able to follow a one step command and be able to participate in group activity. Participants with a Mini Mental Status Exam (MMSE) of less than 24/30 must have consent of authorized representative. Screening of candidates is completed on all NH admissions. Upon completion of the consent process, participants are randomly assigned to either the exercise group or the music/art group. Baseline tests including the DEXA scan, timed performance tests and observation of ADL is completed prior to participation in activity. At the conclusion of four months of activity, all baseline tests are repeated.
A total of ninety one (91) participants completed the study. Data clean up has been completed and preliminary analysis is underway. We do not have any findings at this time. A concept from the art and music activity, "Collage, A Tool for Discovering the Individual" was developed and presented as a poster presentation at the 12th National Alzheimer's Association Educational Conference in July 2004. The Sensory Stimulation portion of the project was selected as the most scholarly abstract at the 2nd Annual Nursing Evidenced Based Practice conference of the University of Maryland School of Nursing in April 2006 and was presented at the 14th National Alzheimer's Association Educational Conference in August 2006. The study with emphasis on the music and art section as a quality of life initiative was the subject of a guest editorial by the Primary Investigator in the Journal of Rehabilitation Research and Development, Volume 42, Number 5, September/October 2005.
The implications of this study for the clinical realm are significant. By improving functional ability of NH residents, the level of care required can be reduced, residents can return to a lower level of care and quality of life can improve.
- Grant M. Collage, A Tool for Discovering the Individual. Paper presented at: Alzheimer's Association Education Annual Conference; 2004 Jul 1; Philadelphia, PA.