Feasibility of the DIGNITY Intervention to Support Person-Centered Risk Management in Rural Nursing Homes

Honoring individual preferences, like going outside, can enhance the health of nursing home (NH) residents living with Alzheimer's disease and related dementias (ADRD). Although a hallmark of person-centered care, honoring ADRD residents' preferences is often restricted when they are perceived to be high-risk for harm by NH staff. Accessible and efficient strategies are needed to help NH staff balance harmful risks to health and safety against the residents' right to make autonomous choices, especially in under-resourced rural areas. This pilot study (NCT05618678) evaluated the feasibility of Decision-making In aGing and demeNtIa for auTonomY (DIGNITY), a multi-faceted and innovative, theory-based, person-centered risk management intervention aimed at assisting NH staff in respecting the preferences of rural residents living with ADRD, while optimizing safety. Feasibility was assessed using retention rates, staff surveys, and qualitative feedback. Fifty-two NH staff participated (88.7% female, 83.3% White, 94.3% non-Hispanic, and 48% with ≥6 years NH experience), with a 79% retention rate and 87.8% survey response rate. In the DIGNITY group, average scores (on Likert scale of 1-5) indicated high feasibility (3.99), acceptability (4.19), and appropriateness (4.24). Qualitative feedback highlighted the value of in-person training and telemonitoring sessions. The high ratings for feasibility, acceptability, and appropriateness of DIGNITY show its potential for supporting NH staff to more confidently provide person-centered care for ADRD residents.