Integrating Working Memory Exercises With Nursing Home Rehabilitation to Achieve “Better, Faster” Functional Outcomes

摘要

Supplemental Digital Content is Available in the Text. Targets: We examined the efficacy of working memory exercises (WME), applied concurrently with rehabilitation services provided in skilled nursing facilities, for improving activities of daily living (ADLs) among older skilled nursing facilities residents with cognitive impairment. Intervention Description: Participants (N = 63) were randomized to the WME or treatment-as-usual control group. The WME was a 3-week, 9-session course (30 minutes each) of a rehabilitation program for therapists in post–acute settings. Mechanisms of Action: Working memory exercises aim to improve ADLs by targeting attention and working memory, based on the link between executive function and everyday functional skills. By developing cognitive communication skills and strengthening strategies for learning and memory, WME may give patients an added boost to traditional ADLs remediation therapies. Outcomes: Working memory exercises participants' ADL performance increased by 1.59 points on average (95% confidence interval = 0.69-2.49, P < .001) on the Katz Index of ADL scale compared with a 0.05 decrease for the control group (95% confidence interval = ?1.09 to 0.99, P = .92). A greater proportion of WME participants than controls progressed from ADL dependent to independent for continence, dressing, feeding, functional transfers, and toileting. Simultaneously targeting cognitive and functional skills was associated with greater improvements in ADLs than targeting functional deficits alone.