JMIR Publications

ABSTRACT

Background:

Adults with Alzheimer’s disease (AD) or related dementias (ADRD) who require a wheelchair to accommodate disease-associated decline in mobility are at elevated risk for developing pressure injuries. In long term care (LTC) facilities, bed-based technologies facilitate prevention efforts, but similar technologies have not yet been widely evaluated to address sitting-related pressure injuries.

Objective:

From a user-centered design perspective, we aimed to understand the types and use of sitting-related equipment used by residents with AD/ADRD. We also aimed to identify challenges faced by caregivers in LTC in adhering to published clinical guidelines around repositioning seated residents and their preferences around the use of sitting-related feedback technologies to facilitate effective and timely repositioning.

Methods:

Two surveys (n=30) and semi-structured interviews of administrative (n=3) and direct care providers (n=6) in LTC facilities were administered. Survey results were summarized and interview responses were analyzed using a thematic analysis approach.

Results:

Stakeholders reported an understanding of the clinical guidelines, awareness of their facility’s pressure injury prevention policies, and access to appropriate seating and mobility equipment. A primary barrier expressed by direct care providers was lack of time to adhere to repositioning schedules and increasing difficulty in advanced stages of AD/ADRD due to resident’s agitation or resistance to being repositioned. Direct care providers expressed interest in technologies that provide automatic repositioning, monitoring of repositioning schedules, and reminders or other types of feedback to facilitate their care efforts as residents become more dependent. For earlier stages of memory loss, they reported that the resident may be able to engage with technologies to facilitate movement.

Conclusions:

These findings suggest that in the LTC context, direct care providers may prefer technologies that reduce their physical care burden, increase their efficiency, as well as compensate for the cognitive load of remembering to reposition residents when they are busy with residents who are dependent on them for managing pressure.