Yap Submits NIH R01 Application

Kudos to Tracey Yap and her entire team for the submission of her NIH R01 Diversity in Health-Related Administrative Supplement application entitled "Describing the Orientation Patterns and Movement of Nursing Home Residents with Dementia." This proposal requests funds for a two-year period with a start date of April 1, 2019.

A disproportionate number (60%) of nursing home (NH) residents with dementia develop a pressure injury/ulcer (PrU) during their stay. PrUs occur due to prolonged pressure over a bony prominence that occludes blood flow, causing death to tissues. Dementia’s pathophysiological effects on motor and sensory pathways predisposes residents to immobility which is associated with increased exposure to prolonged pressure and increased risk for developing a new PrU. The behavioral symptoms of dementia may influence NH residents’ movements and are thought to influence the resident’s ability to effectively engage in self-initiated repositioning and participation in nurse assisted repositioning, both of which may influence the residents risk for PrU development. This study’s purpose is to describe the body orientations, movement patterns, and mobility of NH residents with dementia. Additionally, residents with dementia will be observed during repositioning events to identify potential behaviors that affect their ability to participate in repositioning and their risk for pressure ulcer development, followed by semi-structured interviews with nursing staff to understand from their perspective what resident behaviors are ineffective during repositioning events. The specific aims of this study are to describe: 1) body orientations among dementia residents including the average length of time spent in each direction and most prevalent orientations throughout a 24-hour period; 2) movement patterns and mobility among dementia residents including differences according to time of day; and 3) dementia resident’s common behaviors and responses during repositioning events, whether self-initiated or assisted, that affect the ability of the resident to appropriately off-load and sustain pressure relief for areas at risk of PrU development. Using a descriptive study design with a mixed methods approach, data collected from three NHs enrolled in the Turn Everyone And Move for Ulcer Prevention (TEAM-UP) cluster randomized controlled trial2 will be examined in a retrospective primary analysis of position and movement of NH residents with dementia with additional prospective semi-structured interviews with nursing staff to identify staff perceptions of dementia associated behaviors that affect repositioning and may contribute to increased PrU risk across dementia severity levels. Residents with dementia will be identified using electronic medical record and Minimum Data Set data. Body orientation and movement pattern data will be analyzed from triaxial accelerometer real-time data already collected via wireless sensor worn by each resident for up to a 4-week period. Also, observations of self and assisted repositioning behaviors and interviews with nursing staff will identify how dementia symptoms affect risk for PrU development. This proposed study will be the first to describe the body orientation and movement patterns of NH residents with dementia and will inform future research to tailor PrU prevention strategies according to the various severity levels of the disease.