University of Maryland School of Nursing
Pilot Pragmatic Trial of a Meaningful Activity Intervention in Assisted Living
Health Care Systems
University of Maryland School of Nursing
Dr. Holmes is an associate professor at the University of Maryland School of Nursing, Department of Organizational Systems and Adult Health. Her research focuses on developing approaches to improve long-term care environments and optimize quality of life, decrease behavioral symptoms of distress, and increase meaningful activity engagement among residents. She led the development and testing of Meaningful Activity for Assisted Living (MAC-4-AL), a person-centered approach designed to help residents with dementia engage in meaningful activities aligned with their interests, preferences, and abilities. This award will provide the opportunity to evaluate the feasibility of conducting an embedded pragmatic clinical trial (ePCT) of MAC-4-AL for residents with dementia in assisted living communities and generate evidence to support a future full-scale ePCT.
RATIONALE: People living with dementia (PLWD) residing in assisted living communities (ALCs) often lack opportunities to participate in meaningful activities. Lack of engagement can contribute to distressing symptoms and behaviors. In a prior efficacy trial, the Meaningful Activity for Assisted Living (MAC-4-AL) intervention demonstrated reductions in behavioral symptoms and increased meaningful activity engagement among PLWD in ALCs. The next critical step is to determine whether MAC-4-AL is effective when integrated into the routine care in ALCs.
OBJECTIVE: To conduct a pilot embedded pragmatic clinical trial (ePCT) to determine the feasibility of conducting a full scale ePCT evaluating the effectiveness of MAC-4-AL among PLWD residing in ALCs.
SETTING: Six ALCs in Maryland providing care to PLWD.
POPULATION: PLWD residing in ALCs.
INTERVENTION: MAC-4-AL is a person-centered intervention that promotes meaningful activity engagement among PLWD and which is designed to be embedded within routine ALC.
FEASIBILITY ENDPOINTS AND CLINICAL OUTCOMES: Key feasibility endpoints (thresholds of success) include: Enrollment: identification of eligible PLWD using the ALC electronic health record (EHR) (>80%); Implementation: receipt of all four MAC-4-AL steps (>90%); Implementation: establishment of activity goals by enrolled PLWD (>75%); Implementation: attendance of enrolled PLWD in MAC-4- AL weekly programming (>75%); and Clinical outcome ascertainment: Obtaining the primary and secondary clinical outcomes from the EHR at 6-months (80%). The primary clinical outcome is a scale measuring distressing symptoms behaviors using items from the electronic Maryland Resident Assessment Tool. A secondary clinical outcome is psychotropic use.
IMPACT: This pilot ePCT will provide the preliminary data to support the feasibility of conducting a future full-scale ePCT testing the effectiveness MAC-4-AL in ALCs to reduce distressing symptoms and behaviors, and psychotropic medications among PLWD residing in ALCs.