Reasoning Exercises in Assisted Living: a cluster randomized trial to improve reasoning and everyday problem solving

Kristine Williams,1 Ruth Herman,2 Daniel Bontempo3 1College of Nursing, University of Iowa, Iowa City, IA, USA; 2School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA; 3The Schiefelbusch Institute for Life Span Studies, University of Kansas, Dole Human Development Center, Law...

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Autores principales:	Williams K, Herman R, Bontempo D
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	cognitive training assisted living self-care functional decline Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/4ed949ec05844c9a8ba8b9d0e256bd47
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spelling	oai:doaj.org-article:4ed949ec05844c9a8ba8b9d0e256bd472021-12-02T00:37:01ZReasoning Exercises in Assisted Living: a cluster randomized trial to improve reasoning and everyday problem solving1178-1998https://doaj.org/article/4ed949ec05844c9a8ba8b9d0e256bd472014-06-01T00:00:00Zhttps://www.dovepress.com/reasoning-exercises-in-assisted-living-a-cluster-randomized-trial-to-i-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Kristine Williams,1 Ruth Herman,2 Daniel Bontempo3 1College of Nursing, University of Iowa, Iowa City, IA, USA; 2School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA; 3The Schiefelbusch Institute for Life Span Studies, University of Kansas, Dole Human Development Center, Lawrence, KS, USA Purpose of the study: Assisted living (AL) residents are at risk for cognitive and functional declines that eventually reduce their ability to care for themselves, thereby triggering nursing home placement. In developing a method to slow this decline, the efficacy of Reasoning Exercises in Assisted Living (REAL), a cognitive training intervention that teaches everyday reasoning and problem-solving skills to AL residents, was tested. Design and methods: At thirteen randomized Midwestern facilities, AL residents whose Mini Mental State Examination scores ranged from 19–29 either were trained in REAL or a vitamin education attention control program or received no treatment at all. For 3 weeks, treated groups received personal training in their respective programs. Results: Scores on the Every Day Problems Test for Cognitively Challenged Elders (EPCCE) and on the Direct Assessment of Functional Status (DAFS) showed significant increases only for the REAL group. For EPCCE, change from baseline immediately postintervention was +3.10 (P<0.01), and there was significant retention at the 3-month follow-up (d=2.71; P<0.01). For DAFS, change from baseline immediately postintervention was +3.52 (P<0.001), although retention was not as strong. Neither the attention nor the no-treatment control groups had significant gains immediately postintervention or at follow-up assessments. Post hoc across-group comparison of baseline change also highlights the benefits of REAL training. For EPCCE, the magnitude of gain was significantly larger in the REAL group versus the no-treatment control group immediately postintervention (d=3.82; P<0.01) and at the 3-month follow-up (d=3.80; P<0.01). For DAFS, gain magnitude immediately postintervention for REAL was significantly greater compared with in the attention control group (d=4.73; P<0.01). Implications: REAL improves skills in everyday problem solving, which may allow AL residents to maintain self-care and extend AL residency. This benefit is particularly important given the growing population of AL residents at risk for cognitive and self-care decline. Keywords: cognitive training, assisted living, self-care, functional declineWilliams KHerman RBontempo DDove Medical Pressarticlecognitive trainingassisted livingself-carefunctional declineGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 9, Pp 981-996 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	cognitive training assisted living self-care functional decline Geriatrics RC952-954.6
spellingShingle	cognitive training assisted living self-care functional decline Geriatrics RC952-954.6 Williams K Herman R Bontempo D Reasoning Exercises in Assisted Living: a cluster randomized trial to improve reasoning and everyday problem solving
description	Kristine Williams,1 Ruth Herman,2 Daniel Bontempo3 1College of Nursing, University of Iowa, Iowa City, IA, USA; 2School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA; 3The Schiefelbusch Institute for Life Span Studies, University of Kansas, Dole Human Development Center, Lawrence, KS, USA Purpose of the study: Assisted living (AL) residents are at risk for cognitive and functional declines that eventually reduce their ability to care for themselves, thereby triggering nursing home placement. In developing a method to slow this decline, the efficacy of Reasoning Exercises in Assisted Living (REAL), a cognitive training intervention that teaches everyday reasoning and problem-solving skills to AL residents, was tested. Design and methods: At thirteen randomized Midwestern facilities, AL residents whose Mini Mental State Examination scores ranged from 19–29 either were trained in REAL or a vitamin education attention control program or received no treatment at all. For 3 weeks, treated groups received personal training in their respective programs. Results: Scores on the Every Day Problems Test for Cognitively Challenged Elders (EPCCE) and on the Direct Assessment of Functional Status (DAFS) showed significant increases only for the REAL group. For EPCCE, change from baseline immediately postintervention was +3.10 (P<0.01), and there was significant retention at the 3-month follow-up (d=2.71; P<0.01). For DAFS, change from baseline immediately postintervention was +3.52 (P<0.001), although retention was not as strong. Neither the attention nor the no-treatment control groups had significant gains immediately postintervention or at follow-up assessments. Post hoc across-group comparison of baseline change also highlights the benefits of REAL training. For EPCCE, the magnitude of gain was significantly larger in the REAL group versus the no-treatment control group immediately postintervention (d=3.82; P<0.01) and at the 3-month follow-up (d=3.80; P<0.01). For DAFS, gain magnitude immediately postintervention for REAL was significantly greater compared with in the attention control group (d=4.73; P<0.01). Implications: REAL improves skills in everyday problem solving, which may allow AL residents to maintain self-care and extend AL residency. This benefit is particularly important given the growing population of AL residents at risk for cognitive and self-care decline. Keywords: cognitive training, assisted living, self-care, functional decline
format	article
author	Williams K Herman R Bontempo D
author_facet	Williams K Herman R Bontempo D
author_sort	Williams K
title	Reasoning Exercises in Assisted Living: a cluster randomized trial to improve reasoning and everyday problem solving
title_short	Reasoning Exercises in Assisted Living: a cluster randomized trial to improve reasoning and everyday problem solving
title_full	Reasoning Exercises in Assisted Living: a cluster randomized trial to improve reasoning and everyday problem solving
title_fullStr	Reasoning Exercises in Assisted Living: a cluster randomized trial to improve reasoning and everyday problem solving
title_full_unstemmed	Reasoning Exercises in Assisted Living: a cluster randomized trial to improve reasoning and everyday problem solving
title_sort	reasoning exercises in assisted living: a cluster randomized trial to improve reasoning and everyday problem solving
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/4ed949ec05844c9a8ba8b9d0e256bd47
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Reasoning Exercises in Assisted Living: a cluster randomized trial to improve reasoning and everyday problem solving

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