Abstract

Background: Dementia is a neurodegenerative disorder that is associated with a progressive decline in cognitive function that slowly robs people of the ability to function independently. Community Living Centers (CLCs) provide care for approximately 20,000 Veterans with dementia annually, many of whom have comorbid conditions such as posttraumatic stress disorder and traumatic brain injury that can complicate their care. CLC staff receive limited training in strategies for engaging residents with dementia in meaningful activities and managing dementia-related behaviors, and this training gap can result in low quality of life for residents and suboptimal care. We have developed an innovative group movement program for Veterans with dementia called Preventing Loss of Independence through Exercise (PLIÉ). The goal of this study is to refine PLIÉ for CLCs and develop and pilot-test remote staff training procedures so that PLIÉ can be widely implemented. Significance/Impact. Our proposal is directly responsive to the following 2019 HSR&D Priority Areas: Long-Term Care/Aging and Population Health/Whole Health. In addition, it employs rigorous implementation science methods and is designed to address the ORD-wide research priority of increasing the real-world impact of VA research. Innovation. PLIÉ capitalizes on recent discoveries in neuroscience, behavioral psychology and integrative health and shifts the paradigm of care by targeting abilities and neural mechanisms that are maintained, rather than lost, in the setting of dementia. This includes the ability to learn new movement sequences through procedural or ‘muscle’ memory; the ability to calm the mind and increase attention through mindful body awareness and breathing; and the ability to connect in meaningful ways with others. PLIÉ was originally designed for and tested in adult day programs that contract with VHA, and results to date suggest that participants are experiencing clinically meaningful improvements in quality of life and mobility (standardized effect sizes >0.4) and high levels of caregiver satisfaction. In 2017, we received a VA Innovators Award that enabled us to pilot PLIÉ at the San Francisco VA CLC (PLIÉ-CLC). Participants gave the program high satisfaction ratings (mean: 4.75 on 5-point Likert scale) and reported noticeable physical and emotional benefits in themselves and others. SFVA CLC staff are continuing to implement the program with positive results. Dr. Barnes was nominated for a Federal Executive Board Employee of the Year Award in 2018 for her ground-breaking work on the PLIÉ program. Specific Aims. 1) To identify barriers and facilitators to implementation of PLIÉ-CLC by conducting semi-structured interviews with VHA leaders, CLC directors and CLC staff. 2) To refine PLIÉ-CLC to maximize its scalability and potential for implementation and develop remote training procedures through iterative Plan- Do-Study-Act (PDSA) cycles at two local CLCs. 3) To assess feasibility and provide proof-of-concept for PLIÉ- CLC implementation by piloting remote training procedures at 4 CLCs sequentially. Methodology and Expected Results. This mixed-methods pre-implementation study will include key informants (Aim 1) and CLC residents, clinical champions and instructor trainees (Aims 2 and 3). The expected result is that PLIÉ will be successfully adapted for CLCs, that remote training materials and procedures will be fully developed by the end of the 3-year study, and that pilot data will support the feasibility and potential clinical benefits of implementation. Next steps/Implementation: We will seek funding to perform a type II hybrid effectiveness- implementation study and will work with VHA operational partners (see letter of support from Office of Geriatrics and Extended Care) to disseminate PLIÉ-CLC nationally, including working with community-based organizations that provide care to Veterans with dementia and caregivers as part of the MISSION Act.

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DRA: Mental, Cognitive and Behavioral Disorders, Aging, Older Veterans' Health and Care, Health Systems

DRE: Prevention, Treatment - Implementation, TRL - Applied/Translational

Keywords: Dementia, Functional Status, Outcomes - Patient, Quality of Life

MeSH Terms: None at this time.