Community Health Education for a Patient With HIV Dementia

Program settings and target groups

In 2016, One Brooklyn Health (OBH) was established to preserve and enhance healthcare services in the communities of Central Brooklyn. It compared three Hospitals and their facilities, Interfaith Medical Center (IMC), Brookdale Hospital Medical Center (BHMC), and Kingsbrook Jewish Medical Center (KJM). All three hospitals have had historical ties in their communities and are working together to build a system that will enable OBH to provide the highest quality and widest breadth of healthcare services to those in need. In addition, OBH has two large nursing homes within its system, Schulman and Schachne Institute for Nursing and Rehabilitation at Brookdale Hospital Medical Center and Rutland Nursing Home at Kingsbrook Jewish Medical Center. OBH also has senior citizen housing for residents who can live independently or who require an assisted living program at its Arlene and David Schland Pavillon and clinics at Brookdale Hospital Medical Center.

The program

This community project addresses health education using ESSENTRICS for HIV Associated with Dementia in a Community Learning Setting. ESSENTRICS is a dynamic, full-body workout that simultaneously combines stretching and strengthening while engaging all 650 muscles. The following activities are to be done since activities play a significant part in dealing with challenging behaviors: walking, cycling, gym work, etc. Patients will be educated to exercise daily for about 15 minutes. It is a fact that regular exercise is part of a healthy lifestyle. Exercise for Dementia can improve the ability to perform everyday tasks. When practiced, they increase the ability of the right and left sides of the brain to process information independently of each other (Winner, 2022). A person with Alzheimer’s disease gains the same kind of benefits from regular exercise as anyone else, including improved cardiovascular fitness, strength, and endurance. Exercises may include walking, cycling, gym work, etc. To not that for the program to be well implemented, patients will be divided into two groups with a reasonable time of 30 minutes with each group.

Demographics/ the target group

Shulman & Schachne Institute for Nursing & Rehabilitation in Brooklyn, New York, is a part of One Brooklyn Health and consists of 120 HIV and 44 Alzheimer’s Dementia patients and more specialties. The HIV unit is the only dedicated, certified HIV unit for long-term care in Brooklyn. On 2 South, The institute services 44 residents HIV Associated with Dementia between the ages of 40 – 70 years old with 26 males and 18 females, including 34 African Americans, 6 Latinos, 3 Haitians, and 1 Caucasian. Among the residents, 19 are able to ambulate independently, using wheelchairs 17, recliners 4, and rolling walkers 4. The employees taking care of the residents are 12 Certified Nursing Assistants, 6 License Practical Nurses, and 4 Registered Professional Nurses for all three different shifts.

The setting of the program

The program will be happened in a large dining room area for residents in recliners, using rolling walkers, residents in wheelchairs, ambulatory residents, and two tables for the staff to assist for safety. The program will take place twice a week for 60 minutes for the duration of 6 weeks.

Planning committee/ stakeholders

Since the patients with HIV Associated with Dementia are the target population, the healthcare personnel are going to lead the program. Also, based on its importance for the patients and everyone, other people might be interested, such as local government, social health groups, etc.

Rationale

Health Problem

As a syndrome of cognitive impairment, Dementia makes self-sufficiency difficult to achieve. There were approximately 47.47 million cases of Dementia in the world in 2015 (Taimoor et al., 2022). According to the American Academy of Neurology (AAN), a diagnosis of the human immunodeficiency virus (HIV)-associated dementia requires abnormalities in at least two perceptual (non-motor) domains in addition to a malformation in motor function or specified neuropsychiatric/psychosocial domains (HAD) (Taimoor et al., 2022). When it comes to HIV-related Dementia, the same is true. Alzheimer’s disease is the second leading cause of death worldwide, after smoking, among people older than 60.

The economic costs of HIV dementia are enormous. HIV dementia can lead to a loss of income for those who have lost their ability to work and can no longer contribute to the economy. It also threatens their families, as they may be forced to take care of them without the means to do so (Aranda, 2021). Additionally, financial security is threatened due to disabled people’s inability to provide for themselves or their loved ones.

Furthermore, there are health issues that go along with HIV dementia, such as poor nutrition and high levels of stress that increase the likelihood of poor health outcomes. Finally, there is an increased risk of homelessness due to the fact that people with HIV dementia often require long-term care that can cost thousands of dollars per month or even more than $100,000 per year of care.

Dementia caused by HIV can have devastating effects, including difficulty thinking, concentrating, or speaking, loss of interest in activities, and gradual loss of motor skills. Memory loss is one of the most common symptoms of Dementia (Philips et al., 2019). It is possible that you will experience a decline in your motor skills and an increase in apathy due to this condition. As a result, HIV dementia needs to be treated with accuracy and precision, taking into consideration the need to avoid further impairing the patient’s cognitive abilities. Sub-Saharan African countries have a high prevalence of the HIV/AIDS virus, which has been linked to mental and neurological decline. Despite this, these problems are still widely unrecognized. Our study’s goal is to improve the quality of life for these individuals and their caregivers.

The implementation of the “ESSENTRICS” program is the strategy that has proven to be the most successful in the fight against and management of HIV dementia. It is based on the idea that exercise can help people with HIV maintain their mental health and reduce the symptoms associated with the disease, such as depression and Dementia. Combination antiretroviral medication (ART) effectively controls HIV infection, allowing many HIV-positive people to avoid developing AIDS dementia complex (Brooks et al., 2019). Patients with advanced HIV illness may get partial or complete symptom relief with ART.

Patients with HIV and Dementia are at increased risk of cognitive impairment due to a number of factors. These include the presence of HIV and the fact that this virus impacts immune cells in such a way that they can no longer protect against neurotoxins.

This means that people who have HIV may be more susceptible to developing Dementia than those without the virus. For example, some studies have found that people with HIV are more likely to develop Alzheimer’s disease than those who do not, even if they start treatment early enough (Kopstein, 2022).

This is a problem because Dementia can have devastating effects on the lives of those who live with it. It increases their risk for hospitalization, can prevent them from caring for themselves, and makes them more likely to be a burden on their families (Kopstein, 2022).

The reasons for addressing this issue are as follows: first, it can lead to other health consequences and an increased risk of death. Second, it can cause social isolation, which can be devastating for people who rely on others for daily tasks such as cooking and laundry. Third, it puts strain on families and caregivers, and finally, if the condition worsens, treatment is prohibitively expensive.

One of the most difficult aspects of HIV/AIDS is the AIDS dementia complex (ADC), which affects both the patient and their caregivers. There are cases of Dementia where the patient deteriorates over the course of months to the point where they require constant care. They lose the ability to communicate and gradually become immobile, at which point they require constant assistance. Their mental and physical well-being, as well as their relationships with loved ones, colleagues, and friends, are all negatively impacted by this disease. One may feel hopeless, depressed, frustrated, angry, or resentful.

Proposed solution

The proposed solution to this problem is to develop a regular physical activity program using ESSENTRICS to delay Dementia among HIV patients and to prevent the progress of Dementia among those who are HIV positive. ESSSENTRICS is an acronym for “Exercise Systems for Seniors with Neurologic Disorders and Dementia” (Zarco, 2021). The program was developed by a group of researchers at the University of Kansas who wanted to create something different from what was already available for seniors with Dementia. They worked with experts in geriatric medicine and physical therapy, as well as neurologists, who devised an exercise regimen that would be easy to follow and help patients develop new skills like balance and strength.

The ESSSENTRICS exercises program requires no equipment beyond what participants already have—they do not even need special footwear (Zarco, 2021). Participants need to wear comfortable clothes, stand on a flat surface (like a carpeted floor), and do whatever it is they can do right then and there: sit, stand, and walk around the room. Whatever makes them most comfortable.

The program includes four sets of exercises: walking, standing, sitting, and lying on the ground.

This is where we are going to implement the Physical Activity Program using ESSENTRICS – check out Essentrics.com OR ESSENTRICS on YouTube.

• 40 Residents
  • How are mobile
  • How many are bedridden
• 1 RN and 2 LPNs (7 am-3 pm)
• 4 CNAs
• Training will be from Monday to Friday for four weeks
• Training will take place in a dining room

Patients will learn other important skills, health management, and self-discipline as part of their treatment. Values such as health discipline, in which patients are ultimately responsible for their own health, are essential to the program’s success. Patients are also ultimately responsible for their own health.

Theory-Based Framework for Program

The framework

The project framework that will be used for program planning is the Generalized Model. The Generalized Model for Program Planning (GMPP) is a planning model that expresses the relationship between a program and its stakeholders. This model was developed by A.R. Kellar, who found that there were two main factors that affected how long it took to complete projects: the number of people involved in a project and the number of stakeholders. The GMPP is used as a tool for planning because it helps planners determine how many people will be required to complete a given project. The program comprises evaluating the needs, setting goals and objectives, developing an intervention, implementing the intervention, and evaluating the results (Jiménez, 2019).

Framework application

The framework will be applied to the proposed project by using its planning steps to plan for this project. First, the needs of the project will be evaluated. This includes the human, technical, material, and workload resources needed to complete the project. The next step of the framework is about setting the project’s goals. This is all about coming up with the set objectives of what the project is intended to achieve. For instance, in this project, the main goal is to help patients with HIV dementia manage and reduce their symptoms and improve their cognition.

The other step is developing an intervention. In this case, the intervention intended to be used is the ESSENTRICS program for patients with HIV dementia. After developing the intervention, the other phase is implementing it. This phase will help in coming up with strategies for effectively implementing the intervention to achieve the project goal. The last step, according to the GMPP, is evaluating the results. After planning and implementing the project, it is necessary to evaluate the results to check whether the project meets the set goals. In this case, this last phase will check whether the target population has improved symptoms and cognition.

Needs Assessment

Purpose and scope

The project aims to implement an exercise program to prevent or delay Dementia among HIV patients.

This project targets Patients with HIV dementia. The patient must be able to perform simple exercises such as stretching and slow-paced cardio without any difficulties. The scope of this project includes all patients that are HIV positive and under evaluation at the Shulman & Schachne Institute for Nursing & Rehabilitation in Brooklyn, New York. It will be conducted over a period of four weeks.

Patient characteristics include:

-Age (25-65)

-Gender (both)

-Co-morbidities (HIV and Dementia)

-Medications (prescription drugs such as antiretrovirals, antidepressants, antipsychotics, or stimulants).

The project will involve the following participants: Patients with HIV dementia and caregivers. These patients will be under therapeutic recreation, which in this case is the use of the ESSENTRICS program to help them maintain their mobility and cognitive function through exercises. During the program implementation, the CNA will provide support and guidance to the patient during the program and exercises. The CNA will help the patient by providing emotional support and encouragement, helping them to make decisions about their care, and offering practical assistance such as holding equipment or helping with hydration therapy. The patients will be training 30 minutes per day for four weeks.

Data collection and analysis

This project’s data collection and analysis will be done using an electronic health record system. This is because it is the most accurate way to collect and analyze data from patients with HIV dementia (Scholte, 2016). The EHR system will be able to track all of the information relevant to the project, including patient demographics, health history, diagnoses, medications, and more. This process will take place in two phases.

Phase 1: Data Collection

The first phase will involve collecting data from the electronic health record system for each patient participating in the ESSENTRICS exercise program. To do this, I will enter all relevant information into a database that allows me to analyze the data later. The database will include information about the patient, such as name, age, gender, and diagnosis; it will also contain information about their participation in the ESSENTRICS exercise program (such as how many days they attend per week), which may be used later on when analyzing data collected during the phase.

Phase 2 data analysis

After collecting data from participants who have completed the ESSENTRICS exercise program, I will compare their scores on physical functioning measures at the beginning and end of the program using descriptive statistics techniques (e.g., mean, standard deviation). This means that if there were no significant changes in physical functioning between groups over time (i.e., no significant improvement), then we would expect scores on all measures at both time points.

One of the risk factors that are relevant to the program is physical activity. A person who is physically disabled has trouble moving around, walking, and climbing stairs. They may also have trouble doing sports or walking long distances. This can make it hard for them to exercise regularly or participate in other physical activities that require much energy.

People with physical disabilities are also more likely to have other health issues like heart disease, cancer, or diabetes (Manaf et al., 2021). These illnesses can sometimes lead to Dementia as well, making it even harder for people with these conditions to participate in physical activities that are good for their health.

Mission Statement, Goals & Objective

Mission

The mission statement of this project is “combat the HIV-virus associated with dementia in a community setting.” This mission will help determine the project’s overall goal and provide a clear, measurable way that states what is being accomplished and how. This project aims to use education on ESSENTRICS in a community-based setting. The target population is people with HIV, i.e., those who are infected and at risk for developing Dementia. Dementia and HIV have many different risk factors, but both illnesses may have common elements.

Goal

Our main goal is to elicit the practical knowledge of these individuals by teaching and practicing essential life skills beyond their daily routines and incorporating exercises that can enhance their memory, focus, and emotional well-being. This ESSENTRICS program will involve using muscles in the upper body, such as those in the arms and abdominal muscles. These exercises help to improve muscle strength and tone. They also improve balance, coordination, and posture, reducing falls in seniors with Alzheimer’s or other forms of Dementia.

The goal will be achieved by identifying problem areas and providing creative solutions using user research and technology. All identified areas will be discussed with the key stakeholders, and their concerns will be addressed. These concerns will be addressed through the use of training sessions and feedback sessions. Finally, a written plan that considers all the issues identified will be drawn up to ensure the positive adoption of recommendations by all involved.

The other goal is to ensure that as the patients train in various exercises that can help regain their memory, they are also taught to live a healthy lifestyle. A healthy lifestyle can enhance the quality of life for people who have Dementia (Dhana, 2020). A healthy lifestyle can reduce the risk of heart disease, strokes, and diabetes. It will also reduce blood pressure, cholesterol levels, and blood sugar levels. Eating a wide and balanced variety of foods can help maintain a high metabolic rate. Sleep deprivation is another benefit because it defeats a person’s ability to remain alert, function properly, and improve their cognitive abilities.

The healthy lifestyle program will be in the form of a virtual lecture to provide information on a healthy lifestyle. It will be done in groups, where each group will have a health coach and at least one nurse. The sessions will consist of four important points for healthy lifestyle formation. Each session is about 1 hour. After each session, participants can continue the discussion with any questions or concerns they may have.

SMART Goal Formulation

The following SMART objectives will help to attain the goals:

• Specific- health education by using ESSENTRICS for HIV associated with Dementia in a community learning setting.

Equip the patient with the knowledge of various exercises they can do to benefit their health. The objective outcome is to improve the patient’s mental and physical activity.

• Measurable- patients will be divided into two groups, and each group will be trained for 15 minutes. The purpose of the sessions is to ensure that the patients adopt the exercises. Through this, they will become used to doing the exercises, which become their routine.
• Attainable- Using ESSETRICS will help the patients be mentally and physically active. This will increase their alertness and cognition.
• Relevant- reducing the number of patients with HIV associated with Dementia in a community setting. This will help reduce the prevalence of the disease in the community.
• Time- the project will take six weeks.

Intervention

The type of intervention that I will use in this project is health education by use of ESSENTRICS. ESSENTRICS exercises are a type of strength training involving elastic resistance to improve strength, power, and endurance. Elastic resistance is resistance provided by a spring-like object that contracts and expands in response to external forces. The Education, Support, and Safety (ESSENTRICS) program benefits people with Dementia and other cognitive impairments. It provides education and support services for patients, their families, and caregivers (Zarco, 2021). ESSENTRICS exercises are designed to promote healthy lifestyles, improve physical function, and enhance the quality of life.

The main goal of ESSENTRICS is to improve patient functioning by increasing the cognitive capabilities of individuals with Dementia or similar conditions. The exercises promote physical activity by encouraging walking, swimming, and other forms of exercise that increase the oxygen flow in the body. They also encourage self-care by encouraging daily personal hygiene routines for individuals who may be prone to incontinence due to Alzheimer’s disease or another condition related to Dementia or aging (Sampaio, 2021). The program also emphasizes socialization opportunities for individuals who may have difficulty communicating due to language barriers or other cognitive impairments.

Furthermore, these exercises are a great way to improve posture and overall health. They can be done at home, in the office, or even while a person is moving. The exercises help relieve pain in the back, neck, or shoulders while also strengthening your core muscles—which are essential for keeping the person upright and balanced during everyday activities (Sampaio, 2021). These exercises are designed to be easy for the body to adapt to so that they can be started immediately. One does not need any special equipment—just a chair or an exercise mat that can be used to perform these exercises.

ESSENTRICS Exercises Diagram (retrieved from pointerest.com)

Funding and resources

The personnel needed in this project of using ESSENTRICS on patients with HIV-associated Dementia in a community learning setting are:

• A manager will be responsible for the project and its execution. We will need a patient advocate who will be responsible for ensuring that patient safety is paramount and that all concerns are addressed.
• A nurse will be responsible for administering ESSENTRICS and ensuring that it is administered correctly.
• A social worker will be responsible for providing support services to patients.
• A nurse assistant or caregiver will be responsible for helping patients with Dementia access their medications and other needs.

The space and equipment needed for this project are simple: a table, two chairs, and an exercise mat.

The table must be able to hold up to 250 pounds of weight, so it should be sturdy. The chairs must have armrests so they can be used by people with reduced mobility or those who need help getting up from the floor. The exercise mat must be large enough to allow patients to practice their exercises comfortably—it should be at least 12 inches thick. Finally, there will be no significant noise in the area where patients will perform their ESSENTRICS exercises; therefore, we will not need any equipment that makes noise or emits smells.

Curriculum and Industrial Materials

The supplies needed in this project include a variety of things: markers, pencils, and pens (for writing down notes about each patient’s progress), paper towels or tissues (for wiping sweat off of the patients’ faces), and water bottles (for refilling during breaks).

On the side of the curriculum, this project will use a curriculum based on the National Institute of Health’s educational program for caregivers of persons with Dementia and HIV. This curriculum was developed by the National Institute on Aging, the National Institutes of Health, and the Alzheimer’s Association.

The first step in my project is gathering information about best implementing ESSENTRICS exercises in a community learning setting. In order to do this, I will be interviewing staff members at each site. This will help me determine the resources needed for each specific facility and how each site can best implement ESSENTRICS exercises. Then, I will have to create a plan for implementing ESSENTRICS exercises, which includes materials such as markers and cards. The final step in my project would be training all of the staff members at each site on how to use ESSENTRICS exercises effectively.

In addition, I will use computerized and paper-based materials to teach patients how ESSENTRICS exercises can improve their mobility and daily activities at home. My program will provide instructions for performing the exercises in various ways: individually, one-on-one with a therapist; in small groups; or as part of a group activity with other patients. I will also provide instructions for creating customized DVDs or CDs so that patients can practice these exercises without leaving home.

Funding sources

The source of funding for this project will be the National Institute on Aging, which is part of the National Institutes of Health. The National Institute on Aging is a division of the Department of Health and Human Services, which is one of the three federal departments that make up the U.S. government.

The National Institute on Aging provides grants for projects related to brain aging and Dementia, including Alzheimer’s disease, Lewy body dementia (LBD), frontotemporal Dementia (FTD), and other disorders that affect memory and thinking skills. The NIA also provides grants for projects on how genes or environmental factors contribute to Alzheimer’s disease or other dementias (Figg, 2020).

Program Budget

References

Aranda, M. P. (2021). Impact of Dementia: Health disparities, population trends, care interventions, and economic costs. American Geriatrics society. https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.17345

Brooks, T., Kawwass, F., Smith, K., & Kissin, M. (2019, April 8). Effects of antiretroviral therapy to prevent HIV transmission to … Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/66/wr/mm6632e1.htm

Dhana, K. (2020). Healthy lifestyle and the risk of Alzheimer dementia: Findings from 2 longitudinal studies. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455318/

Figg, B. (2020, 3). National Institute on Aging. Taylor & Francis. https://www.tandfonline.com/doi/abs/10.1080/15398285.2020.1752527?journalCode=wchi20

Jiménez, S. (2019). A review of generalized planning. Cambridge Core. https://www.cambridge.org/core/journals/knowledge-engineering-review/article/abs/review-of-generalized-planning/61056E7879134E057677CE0CEDD1339E.

Kopstein, M. (2022, September 20). HIV-1 encephalopathy and aids dementia complex – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK507700/

Manaf, S., Justine, & Hisham. (2021). Barriers to Physical Activity and Exercise Amongst Persons With Physical Disabilities in a Government-funded Teaching Hospital, Kuala Lumpur. ResearchGate | Find and share research. https://www.researchgate.net/publication/351089692_Barriers_to_Physical_Activity_and_Exercise_Amongst_Persons_With_Physical_Disability_in_a_Government-funded_Teaching_Hospital_Kuala_Lumpur

Phillips, N. J., Thomas, K. G., Myer, L., Sacktor, N., Zar, H. J., Stein, D. J., & Hoare, J. (2019). Screening for HIV-associated neurocognitive disorders in perinatally infected adolescents: youth-International HIV Dementia Scale validation. Aids, 33(5), 815–824.

Sampaio, A. (2021). Physical exercise for individuals with Dementia: Potential benefits perceived by formal caregivers. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789403/

Scholte, M. (2016). Data extraction from electronic health records (EHRs) for quality measurement of the physical therapy process: Comparison between EHR data and survey data. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5101697/

Taimoor, H., Andre, C., Khalida, W., Khan, R., Jafrikh, T. K., Khan, T., … & Bhure, V. R. (2022). HIV Dementia: A Bibliometric Analysis and Brief Review of the Top 100 Cited Articles. Cureus, 14(5).

Winner, A ( 2020). Home dementia exercise program increases abilities and improves symptoms, Daily Caring. Retrieved from https://dailycaring.com/dementia-exercise-programs-increase-abilities-and-improve-symptoms/

Zarco, E. P. (2021, January). Perceived benefits of a guided exercise program among older adults. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8766912/

Zarco, P. T. (2021, January). Perceived benefits of a guided exercise program among older adults. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8766912