Exploring Movement Patterns and Repositioning Among Nursing Home Residents With Dementia

Thursday, 25 July 2019: 3:30 PM

Tracey L. Yap, PhD, RN, WCC, CNE, FAAN1
Jinjiao Wang, PhD, RN2
Susan M. Kennerly, PhD, RN, WCC, CNE, FAAN3
Susan D. Horn, PhD, MS4
Thompson Forbes, PhD, RN3
Valerie Sabol, PhD, ACNP-BC, GNP-BC, FAANP1
Tianyu Zheng, MS5
Phoebe D. Sharkey, PhD6
(1)School of Nursing, Duke University, Durham, NC, USA
(2)School of Nursing, University of Rochester, Rochester, NY, USA
(3)College of Nursing, East Carolina University, Greenville, NC, USA
(4)School of Medicine, University of Utah, Salt Lake City, UT, USA
(5)Population Health Sciences Health System Innovation and Research Program, University of Utah, Salt Lake, UT, USA
(6)Department of Management Information, Loyola University Maryland, Washington, DC, USA

Purpose: Sixty five to seventy five percent of nursing home (NH) residents with dementia are likely to develop pressure ulcer/injury (PrU). Repositioning, the common approach to minimizing the time period of pressure exposure, is critical for prevention. Little is known about patterns of movement among NH dementia residents. Repositioning of residents in one NH dementia unit was examined as part of an ongoing clinical trial (ClinicalTrials.gov: NCT02996331, 1R01NR016001-01A1) investigating optimal repositioning intervals. We explored overall resident movement to better understand movement patterns among NH residents with dementia.

Methods: Each resident’s activity was monitored for 3 to 28 days using a triaxial patient monitoring system. Resident (n=31) body orientation, movement, and nursing staff compliance with on-time repositioning were tracked in real time. Demographics (age, gender, race/ethnicity), body mass index (BMI), and repositioning data were summarized using descriptive and non-parametric statistics (Wilcoxon rank sum, Fisher’s exact test).

Results: The predominantly female (65.7%, n=20) resident sample was primarily Caucasian (80.65%, n=25) with a mean age of 77.9 (S.D.=8.48); 3% were over 90 years old. Mean BMI was 27.3 (S.D.=6.45); residents with very low BMI (5, 16.13%) and BMI >30 reflecting obesity (14, 45.16%) comprised the majority of the sample. Mean total time each resident was monitored with triaxial accelerometer was 16.35 days (S.D.=9.93). Body orientations detected were 55% of the time lying in bed, 43% upright sitting in a chair or bed, and 2% up ambulating. No significant differences (p<.05) were observed for 1) time spent in body position, 2) number of position changes, or 3) ambulating when analyzed according to BMI groups.

Conclusions: NH residents with dementia spent 93% of time lying in bed or sitting in chairs, with only 5% spent on movement (changing body positions) and 2% on ambulation. More than half of NH residents with dementia are obese (BMI>30). Nurses should prioritize pressure ulcer prevention among NH residents with dementia. Nurses should also encourage NH residents to increase movement and ambulation, such as walking, meanwhile monitoring patient safety.