The Effectiveness of Function-Focused Care Interventions in Nursing Homes: A Systematic Review.

BACKGROUND: Since the Omnibus Budget and Reconciliation Act was passed in South Korea in 1987, function-focused care (FFC) has been used in long-term care to achieve the highest possible levels of self-care and independence for older adults. However, many perceive nursing home residents with cognitive function impairments as having little restorative potential.

PURPOSE: The purpose of this review is to report on evidence and strategies relating to FFC interventions in nursing home settings and to summarize the effects of FFC on the functional abilities of resident subgroups.

METHODS: A literature review using EMBASE, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature was conducted for articles published between January 1, 2000, and February 20, 2016. Twenty-two eligible studies were identified. Relevant data were extracted, and the results were synthesized into an integrated literature review. Study quality was appraised using the Cochrane Risk of Bias tool and the Risk of Bias Assessment tool for Non-randomized Studies.

RESULTS: This review included 22 trials that were of moderate to high quality. Our systematic review confirmed the FFC interventions as integrated and dedicated processes; the five key strategies underpinning effective FFC interventions; and the effectiveness of FFC interventions on physical, psychosocial, and cognitive functions. The five key strategies underpinning FFC interventions included interactive learning for caregivers, the content of learning programs for caregivers, residents' preferences and interests, optimizing approaches according to residents' functional status, and the conceptual frameworks of FFC interventions. Most of the studies (n = 15) evaluated psychosocial functions and found significant improvements in aspects such as mood, affect, and behavioral problems. Likewise, the 13 studies assessing physical function found significant improvements in effectiveness in aspects such as movement, balance, and activities of daily living. Only four studies looked at cognitive function effectiveness, using measures such as place finding, verbal use, and memory.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Our review found scientific evidence that FFC interventions improve functional abilities across various levels of cognitive function in nursing homes. Nursing homes may employ effective strategies to maximize the effects of FFC interventions and use educational materials to teach caregivers to implement FFC interventions competently.