Evidence-Informed Report on Home Nursing Care for Dementia Patients

This report presents a literature review on providing home nursing care to people with dementia, focusing on evidence-based practices to determine best practice. The report examines the effectiveness of physical activity interventions on improving activities of daily living (ADLs), symptoms, and quality of life in elderly people with dementia living at home. The methodology includes a search of Medline, CINAHL, and Google Scholar, using keywords such as 'elderly patient with dementia' and 'activities of daily living'. The findings highlight various interventions like high-intensity physical exercise programs and multi-component exercise training, revealing their positive impact on muscle strength, balance, and endurance. The discussion section emphasizes the quality of the included studies and addresses limitations like small sample sizes. The report concludes that early initiation of physical activity interventions is beneficial for improving functional capacity and symptoms, recommending early assessment of mobility and functional dependence to maximize independence in ADLs. Finally, the report aligns the evidence-based practice with the Person-Centred Care framework and recommends implementing it into service using Transformational Leadership values. The report is a comprehensive review of the topic, offering valuable insights for healthcare professionals.

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

1NURSING
Table of Contents
Introduction:....................................................................................................................................2
Background:.....................................................................................................................................2
Method:............................................................................................................................................3
Findings:..........................................................................................................................................4
Discussion:.......................................................................................................................................5
Conclusion and Recommendation...................................................................................................6
References:......................................................................................................................................7

2NURSING
Introduction:
Dementia is a neurological disorder that is associated with deterioration in cognition,
memory, thinking, behaviour and ability to perform activities of daily living (ADLs). The disease
affects around 50 million people worldwide and 10 million new cases are diagnosed every year.
It is one of the major causes behind disability and dependence in older patients globally (World
Health Organization, 2020). For family members or caregivers, who are dealing with dementia
patient at home, care giving burden is high because of poor ADLs, loss of concentration,
episodes of hallucination and balance and coordination issues. The inability of dementia patient
in self-care and ADL is an area that further increases their care giving burden. Førsund et al.
(2018) further acknowledge that living with dementia is associated not only with loss in mental
capacity, but also problem in competing daily activities and taking part in social life. In case of
elderly dementia patient, frailty and other co-morbidity become a cause for additional challenges
for patient. Hence, finding out ways by which home based intervention could be provided to
address functional issues and increasing quality of life of dementia patient is important.
Background:
For dementia patient, dependence on ADLs and loss of functional capacity is an area that
has a significant impact on their quality of life (QoL). QoL is multi-dimensional construct that is
dependent on fulfilment of physical, mental and social needs of a person. Majority of patients
diagnosed with dementia need to stay at home and depend on care from their family or friends.
Such form of dependence is seen because of symptoms of aggression, mood swings, memory
loss, poor motor function and loss of body coordination. All these factors together decrease the
independence in ADL and QoL in patient. This has an impact on the quality of life of carers too

3NURSING
(Opara, 2012). ADLs involve all those activities to manage physical needs such as hygiene,
dressing, ambulating, eating and continence (Mlinac & Feng, 2016). The main impact of activity
dependence is that it leads to poor emotional as well as social outcomes in dementia patient.
They prefer staying alone instead of going out. This group of dementia patients are likely to have
heterogeneous etiologies such as co-morbidities (Gure et al., 2013). Hence, finding out home
based intervention that could increase independence in ADLs would be crucial to enhance QoL
of patient. As part of home nursing care, physical exercise has been identified as an effective
intervention to improve symptoms and enhance functional abilities of dementia patient. This
makes it even more important to identify evidence based strategies to promote ADLs. Evidence
has shown the benefits physical activity intervention on promoting ADLs in patient and finding
out more about how this intervention influence outcome of dementia patient will be crucial in
enhancing their QoL (Prizer & Zimmerman, 2018). With this purpose, the aim of this literature
review is to search, identify and evaluate the effectiveness of PA intervention on improving
ADLs, symptoms and quality of life in elderly people with dementia living at home.
Method:
To find articles related to the PICO question, the search for full text and peer reviewed
research articles were done in Medline, CINAHL and Google Scholar. The key words used for
search process included ‘elderly patient with dementia’, ‘activities of daily living’ and ‘capacity
for ADL. Different synonyms were used for the search process and two or more search terms
were combined with the Boolean operator ‘AND’. The filters used included English language
and selecting articles published from 2014 to 2020. Total five articles were included in the
review. Out of five articles, one article was a systematic review paper and rest four were RCT
‘randomized controlled trials’.

4NURSING
Findings:
By reviewing the five research articles on the effectiveness of PA intervention on
outcome and ADLs of elderly patient, different types of interventions were identified to promote
independence in ADLs. These interventions were as follows:
 High intensity physical exercise programs
 Multi-component exercise training such as ADL training on self-care, exercise training
involving alternating strength and aerobic exercise. Strength exercise included chest
press, triceps curls, seated leg extension and hip abduction
 PA intervention focusing on training the lower body on movement
 Physical exercise sessions consisting of strengthening, balance and walking
 Exercise consisting of knee strength exercise, knee bends hold support and rising from
chair one hand
The literature review was successful in demonstrating diverse impact of exercise program
on dementia patient. For instance, Li et al. (2019) revealed the effectiveness of high intensity
functional exercise program on improving lower limb strength, balance and mobility: The RCT
study by Henskens et al. (2018) indicates the positive benefits of 6 months ADL training on
executive function, depression and physical endurance. However, unlike single intervention this
study suggested that combined intervention are more effective in enhancing functional mobility
compared to ADL training. The study was successful in demonstrating the role of nursing staff in
preventing disability for elderly dementia patient by stimulating their independence. In addition,
the study is validated by the results of the multi-site RCT paper by Burge et al. (2016) which
highlighted the efficacy of physical exercise on improving ADL capacity on both moderate and

5NURSING
severe dementia patient. Overall, out of five, four studies were successful in showing the positive
impact of exercise on cognition and ADLs in dementia patient.
Discussion:
The findings of this review revealed the clinical benefits of physical exercise on different
domains of ADLs such as muscle strength, balance and endurance. The strength of the review is
that it included only systematic review and RCT papers. Both these research design are top
quality of evidence in the evidence hierarchy and they are credible evidence to give idea about
the clinical value and efficacy of an intervention in a population. Rigorous research methods and
consideration of biases makes these research designs reliable for application into real practice
(Murad et al., 2016). There were four RCT papers and most of them included different duration
of physical exercise intervention. Henskens et al. (2018) evaluated outcome of PA at baseline, 3
and 6 months. Evaluation of outcome in three periods helped in finding out the pros and cons of
the intervention in different stages. The study measured improvement both in physical
functioning as well as mood and behaviour. However, one common limitation that has been
found in most of the paper is that they included small sample size. The pilot RCT study by
Holthoff et al (2015) lacked generalizability because of low sample size too. Despite this, the
strength of the study was that it evaluate efficacy of PA training delivered at home. This is most
relevant with the research problem and the findings presented are applicable to home based
settings too. It gives guidance on equipments on procedure needed for home based PA training.
The only exceptional study in the review was the study by Burge et al. (2016) which indicates
that PS may delay loss of mobility but it cannot have significant impact on overall ADL scores.
This score was obtained because most of the patients had severe deficits. Thus, the study gives
the implication to initiate PA intervention at home at an early stage before symptoms of

6NURSING
dementia patient deteriorate significantly. Zeng et al. (2016) acknowledged too that early
physical exercise can enhance function of dementia patients.
Conclusion and Recommendation
From the literature review on the effectiveness of PA intervention on enhancing ADLs in
dementia patient, it can be concluded that early initiation of such intervention is beneficial in
improving functional capacity and symptoms of patient. The positive effect is likely to be seen
after six months of the intervention. To ensure greater positive effect, it is recommended that
assessment of mobility and functional dependence is done at the early stage of disease. This will
help to achieve maximum independence in ADLs by initiating PA programs for elderly dementia
patients at home.

7NURSING
References:
Bürge, E., Berchtold, A., Maupetit, C., Bourquin, N. M. P., von Gunten, A., Ducraux, D., ... &
Kuhne, N. (2017). Does physical exercise improve ADL capacities in people over 65
years with moderate or severe dementia hospitalized in an acute psychiatric setting? A
multisite randomized clinical trial. International psychogeriatrics, 29(2), 323-332. DOI:
10.1017/S1041610216001460
Førsund, L. H., Grov, E. K., Helvik, A. S., Juvet, L. K., Skovdahl, K., & Eriksen, S. (2018). The
experience of lived space in persons with dementia: a systematic meta-synthesis. BMC
geriatrics, 18(1), 33. https://doi.org/10.1186/s12877-018-0728-0
Gure, T. R., Langa, K. M., Fisher, G. G., Piette, J. D., & Plassman, B. L. (2013). Functional
limitations in older adults who have cognitive impairment without dementia. Journal of
geriatric psychiatry and neurology, 26(2), 78–85.
https://doi.org/10.1177/0891988713481264
Henskens, M., Nauta, I. M., Van Eekeren, M. C., & Scherder, E. J. (2018). Effects of physical
activity in nursing home residents with dementia: a randomized controlled trial. Dementia
and geriatric cognitive disorders, 46(1-2), 60-80. doi: 10.1159/000491818
Holthoff, V. A., Marschner, K., Scharf, M., Steding, J., Meyer, S., Koch, R., & Donix, M.
(2015). Effects of physical activity training in patients with Alzheimer’s dementia: results
of a pilot RCT study. PloS one, 10(4). https://doi.org/10.1371/journal.pone.0121478
Lee, H. J., & Kim, K. D. (2018). Effect of physical activity on cognition and daily living
activities of the elderly with mild dementia. Journal of physical therapy science, 30(3),
428-433. DOI: 10.1589/jpts.30.428

8NURSING
Li, X., Guo, R., Wei, Z., Jia, J., & Wei, C. (2019). Effectiveness of Exercise Programs on
Patients with Dementia: A Systematic Review and Meta-Analysis of Randomized
Controlled Trials. BioMed Research International, 2019.
https://doi.org/10.1155/2019/2308475
Mlinac, M. E., & Feng, M. C. (2016). Assessment of activities of daily living, self-care, and
independence. Archives of Clinical Neuropsychology, 31(6), 506-
516.https://doi.org/10.1093/arclin/acw049
Murad, M. H., Asi, N., Alsawas, M., & Alahdab, F. (2016). New evidence pyramid. BMJ
Evidence-Based Medicine, 21(4), 125-127.http://dx.doi.org/10.1136/ebmed-2016-110401
Opara J. A. (2012). Activities of daily living and quality of life in Alzheimer disease. Journal of
medicine and life, 5(2), 162–167.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3391877/
Prizer, L. P., & Zimmerman, S. (2018). Progressive support for activities of daily living for
persons living with dementia. The Gerontologist, 58(suppl_1), S74-
S87.https://doi.org/10.1093/geront/gnx103
World Health Organization. (2020). Dementia. Retrieved from: https://www.who.int/news-
room/fact-sheets/detail/dementia
Zeng, Z., Deng, Y. H., Shuai, T., Zhang, H., Wang, Y., & Song, G. M. (2016). Effect of physical
activity training on dementia patients: A systematic review with a meta-analysis. Chinese
Nursing Research, 3(4), 168-175. https://doi.org/10.1016/j.cnre.2016.11.006