Function-Focused Care for LTC Residents with Moderate-to-Severe Dementia: A Social Ecological Approach

 Over one-third of long-term care (LTC) residents exhibit moderate-to-severe cognitive impairment. These residents are more likely to be inactive, require assistance with activities of daily living, have medical comorbidities, and be exposed to fewer opportunities to engage in functional and physical activities than peers who are cognitively intact or have only mild cognitive deficits. This article will discuss factors that influence the functional performance of older adults with dementia, and benefits and barriers to implementing a function-focused philosophy of care for LTC residents with dementia. Specific strategies for implementation of function-focused care with this population will be described using a social ecological framework. (Annals of Long-Term Care: Clinical Care and Aging 2010;18[6]:27-32)

Alzheimer’s disease (AD) and other related dementia syndromes present a significant public health problem for the aging population in the United States. Given the progressive deterioration in cognitive and functional abilities associated with the majority of dementia syndromes, it is estimated that by the year 2020, more than 3 million older adults with moderate-to-severe cognitive impairment will require nursing home (NH) care. Even without the impact of acute illness, significant decline in functional abilities, including bed mobility, transfer, locomotion, dressing, eating, toileting, and personal hygiene, occurs within six months among NH residents with moderate and severe cognitive impairment.