Photograph of a man doing home repairs in an older adult's home; photo source: Administration on Aging, DHHS Learning Activities

Maximizing Function Competency

Plan, implement, and evaluate care that assists older adults and their families/caregivers to meet personal goals, express preferences, maximize function, maintain desired level of autonomy and independence, and live in their chosen environment.


Develop your Maximizing Function Competency by completing some or all of these learning activities. Choose the ones that are the most useful and appealing as you prepare to demonstrate your Maximizing Function Competency. You might want to explore them all, to see what resources are here for sharing with others in your work setting or community.

 

Photograph of a hand holding a toothbrush. The handle of the toothbrush has a washcloth wrapped around it and secured with rubber bands.

 

Introductory Video for the Maximizing Function Competency

 

 

 

              

If you prefer, you can read a transcript of the video.

Overview of Learning Activities:  Learning Activities for the Maximizing Function Competency are divided into three major areas of focus:

Optimizing Person-Environment Fit to Maximize Function

An older adult may live in the same house for many years. We sometime call this phenomenon "aging in place." 

As a person ages, the combined effects of functional, sensory, and cognitive changes of aging plus the development of disease processes that are more common with aging may create a suboptimal person-environment fit between the person and his or her home environment.  Photograph of a person holding two shapes whose edges do not fit smoothly together
                                               
Photograph of a person holding two shapes whose edges fit smoothly together    Optimizing person-environment fit to maximize function may enable an older adult to continue to live at home as function changes. 

Print a Fact Sheet

This Home Modification Fact Sheet from the Administration on Aging presents practical aspects to consider when planning home modifications for aging in place.

Watch a Presentation about Preventing Falls

Cartoon of a man who is falling and a woman who is trying to catch him  You focused on risk factors for falls in the Adapting Care Competency. Now, focus on modifying the home environment as one way to prevent falls. 

Watch the presentation Toward Fall Prevention. This presentation uses the person-environment fit framework. After you watch it, read the Home Modification Fact Sheet again. How many of the suggested home modifications are useful to prevent falls? What other environment issues are addressed in the presentation? 

If you are interested in the evidence base for recommending Tai Chi for fall prevention, perform a literature search in MEDLINE or CINAHL using the key words Tai Chi (or Tai Ji) and accidental falls. Here is one article you might appreciate:

Wooton, A.C. (2010). An integrative review of Tai Chi research: an alternative form of physical activity to improve balance and prevent falls in older adults. Orthopaedic Nursing, 29(2), 108-116; quiz 117-118.

Read an Article (or Two) about Environmental Modifications Picture of two journal articles     

The term environmental modifications encompasses both home modifications, as introduced above, and assistive devices

Family Caregivers and Environmental Modifications

Messecar, D.C. (2000). Factors affecting caregivers' ability to make home modifications. Journal of Gerontological Nursing, 26, 32-42. 

Helping People Age in Place

Fielo, S.B., & Warren, S.A. (2001). Home adaptation: Helping older people age in place. Geriatric Nursing 22(5), 239-247.

Consider Assistive Devices to Maximize Function

Photograph of hands of a woman who has severe osteoarthritis; photo source: OHSU Digital Resources Library  Many older adults have difficulty with hygiene and dressing due to the effects of various pathophysiologies, such as osteoarthritis. Assistive devices matched to their individual capabilities can maximize function.

Presentation: Assistive Devices to Maximize Function: Aids for Hygiene and Dressing

Presentation: Helping Hands: Medication Aids

Read an Article about Maximizing Function in Hospital Environments Picture of two journal articles     

Inouye, S.K., Bogardus, S.T., Baker, D.I., et al. (2000). The hospital elder life program: A model of care to prevent cognitive and functional decline in older hospitalized patients. Journal of the American Geriatrics Society, 48(12), 1697-1706.

  • As you read, pay particular attention to the following:
    • Description of the Program: Overview
    • Table 1: Hospital Elder Life Program Interventions
    • Discussion
    • Then reread the abstract.
  • What are two interventions that might be possible in your work setting?

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Managing Challenging Behaviors

Drawing of a dark cloud, a symbol for challenging behaviors  Nurses and other professionals who work with older adults may encounter challenging behaviors that include combative behavior, wandering, and interference with therapeutic devices or procedures. Restraints have sometimes been used in the past in these situations. This section focuses on restraint-free care and prevention of combative behavior.

Learn about Providing Restraint-Free Care

The use of restraints for older adults in either hospitals or long-term care settings is associated with poor clinical outcomes.

If you work in a hospital, read this evidenced-based guidance for providing restraint-free care:

Avoiding Restraints in Older Adults with Dementia
http://consultgerirn.org/uploads/File/trythis/try_this_d1.pdf

Diversion, a Method of Preventing Restraints: Therapeutic Activity Kits
http://consultgerirn.org/uploads/File/trythis/try_this_d4.pdf

If you work in long-term care, this resource is for you:

Restraint-Free Care
http://www.healthcare.uiowa.edu/igec/publications/info-connect/assets/restraint_free_care.pdf

Note: The internet links provided here were active at the time these Older Adult Focus materials were prepared. If a link is no longer active, try searching for the same or similar content using the name of the organization or the title provided.

Access Resources about Preventing Combative Behavior during Bathing

Bathing can be a frightening event for persons who have dementia. They may become combative and injure themselves or assistive personnel. Researchers have studied techniques for bathing persons who have dementia. Person-centered bathing is a technique that has been demonstrated to reduce combative behaviors during bathing in persons who have dementia. This technique keeps the focus on the person rather than on the task. 

Read about person-centered bathing: Sloane, P.D., Hoeffer, B., Mitchell, C.M., McKenzie, D.A., Barrick, A.L., Rader, J., et al. (2004). Effect of person-centered showering and the towel bath on bathing-associated aggression, agitation, and discomfort in nursing home residents with dementia: a randomized, controlled trial. Journal of the American Geriatrics Society, 52(11), 1795-1804. 

Additional resource: An excellent educational CD-ROM and videotape, Bathing Without a Battle: Creating a Better Bathing Experience for Persons with Alzheimer's Disease and Related Disorders is available for purchase from http://www.bathingwithoutabattle.unc.edu. The CD-ROM has separate tracks for nurses, nursing assistants, administrators, and caregivers at home. 

Drawing of an ear listening to a story Listen to Clinical Stories about Preventing Combative Behavior during Procedures

Mental imagery can be very useful to prevent combative behavior during procedures that can be painful or stressful for older adults. 

Listen to this true clinical story about preventing combative behavior during a nursing procedure, narrated by Linda Felver, Ph.D., R.N. If you prefer, you can read a transcript of the story.

Here is another true clinical story about using mental imagery to prevent combative behavior by an agitated older adult, also narrated by Linda Felver, Ph.D., R.N. If you prefer, you can read a transcript of this story.

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Working with Older Adults and Caregivers 

Drawing of a man who is the caregiver for his wife. They are talking with a social worker.  Many older adults are taking care of their spouses or other family members at home. These family caregivers face special challenges in their own aging. 

View a Presentation about Family Caregiving   

Adult children frequently become caregivers for their parents. Watch this presentation Assessing and Supporting Family Caregivers for an introduction to the topic and some useful assessments and interventions to maximize function in these households.

If you are interested in a tool to assess caregiver strain, you can find one in this reference:

Sullivan, M.T. (2003). Caregiver strain index. Home Healthcare Nurse, 21(3), 197-198.

Drawing of an ear listening to a story Listen to a Clinical Story about Family Caregiving

Listen to this true clinical story about an important issue in family caregiving, narrated by Linda Felver, Ph.D., R.N. If you prefer, you can read a transcript of the story.

Find Resources for Caregivers Picture of the letters http:

Note: The internet links provided here were active at the time these Older Adult Focus materials were prepared. If a link is no longer active, try searching for the same or similar content using the name of the organization or the title provided.

Visit at least two of the following websites and become familiar with some of the resources available to support family caregivers. You might want to recommend some of these resources to persons whom you know.

Administration on Aging, U.S. Department of Health and Human Services

http://aoa.gov

Use the Eldercare Locator (click Find Local Programs) to find resources in your geographic area for family caregivers. (You can find other resources for older adults using this same Eldercare Locator.) 

National Alliance for Caregiving

http://www.caregiving.org

  • What resources for caregivers can you find on this site? 
  • Which ones would be useful for persons who are just beginning the caregiver role? 
  • Which ones would be useful for persons who have been caregivers for some time and have a high level of caregiver competence? Or, perhaps are feeling high role strain? (Do you need to revisit the presentation Assessing and Supporting Family Caregivers to review caregiver competence and role strain?)

Caregiver.com

http://www.caregiver.com

This site has resources for rural caregivers. Click the word CHANNELS. (It may be a tab at the top of the home page.) Then click Rural Caregiver Channel and explore the materials and links created specifically for rural caregivers. 

You can register for a free weekly e-newsletter for caregivers from this site, if you wish. Use the Newsletters tab at the top of the home page. You may want to share this link with caregivers or other people who work with older adults. 

Family Caregiving 101

http://www.familycaregiving101.org

This educational site is designed for caregivers. 

  • Look at the six stages of caregiving. If you know a family caregiver, try to identify the stage of caregiving for that situation. 
  • What different types of resources do caregivers need in these different stages?

Local Organizations

To locate a caregiver support group, contact the Community Education Department of the nearest hospital or the Alzheimer's Disease and Related Disorders Organization. Local churches may also provide resources for caregivers.

Picture of movie reel Watch a Movie

Watch the movie Iris. Iris is based on the true story of the 40-year relationship between the novelist and philosopher Iris Murdoch and her husband John Bayley, who became her caregiver when she developed Alzheimer’s disease.  

Watch the film and think about the following:

  • What clues did you have about changes in Iris’ ability to think?
  • What difficulties did Iris have with these functions:
    • Language
    • Finding her way in the house
    • Dressing
  • What was her husband's experience with Iris' cognitive changes?
  • How did her husband intervene with her?
  • What changes in the house did you observe?
  • What eventually led to her being placed in a facility?
  • Can you think of some referrals that might have been helpful?
  • Which ones of the following resources would have benefited them? Why? 
    • Home health care
    • Occupational therapy
    • Respite care
    • Meals on Wheels
  • What resources are available to keep individuals who wander safe?
    • Home modifications?
    • Personal identification?
    • Community programs?
  • Finally, think about how you might intervene with this couple if you were a home health nurse and were making a home health visit. 
    • In what ways could you assist them to maximize their function and remain independent in their home together for a little while longer?
Confer with Caregivers

Choose one of these activities to gain more insight into family caregiving and the ways nurses and other professionals can support caregivers:

  • Meet with a family caregiver and ask him or her to tell you about the caregiving situation. 
    • During the conversation, ask what a nurse or other professional can do that is most helpful.
  • Shadow a Home Health Nurse during the admission visit of a frail older adult who has a family caregiver. 
  • Attend a caregiver support group such as a Parkinson or Alzheimer disease support group.
    • What needs are expressed by the family caregivers?

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Complete a Crossword Puzzle Picture of a crossword puzzle

After you have completed some of the learning activities, reward yourself with this Maximizing Function Crossword Puzzle.

After you have completed some or all of these Learning Activities, proceed to the Competency Demonstration.

Developed by L. Felver and C. Van Son; Revised 2010