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Shin JH, Jung SO, Min EJ. Factors Influencing Hospitalization of Nursing Home Residents in Korea Using Regularized Negative Binomial Regression. Policy Polit Nurs Pract 2024:15271544241259427. [PMID: 38874520 DOI: 10.1177/15271544241259427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
The appropriateness of hospitalization for nursing home (NH) residents is still up for debate, with determining factors including timeliness, available treatment, healthcare staff, medication options in hospitals, and safety issues. Although the factors leading to hospitalization have been studied expansively, research on staffing is limited. Thus, this study aimed to investigate organizational predictors, nurse staffing, and government incentives and find important factors to hospitalization due to infection or disease among NH residents in Korea. A cross-sectional design was used, and data were collected via survey from a total of 51 NHs from August 27, 2021 to March 25, 2022. A total of 32 explanatory variables were included. The response variable was the count of hospitalized residents due to infection or disease. We analyzed data using least absolute shrinkage and negative binomial regression. We found that registered nurses' increased hours per resident day were related to decreased hospitalizations due to infection or disease. Appropriate retention and recruitment of nurse staffing with professional leadership should be performed to increase the quality of care for NH residents.
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Affiliation(s)
- Juh H Shin
- School of Nursing, George Washington University, USA
| | - Sun O Jung
- College of Nursing, Ewha Womans University, Korea
| | - Eun J Min
- College of Medicine, The Catholic University of Korea, Korea
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Tay LX, Ong SC, Tay LJ, Ng T, Parumasivam T. Economic Burden of Alzheimer's Disease: A Systematic Review. Value Health Reg Issues 2024; 40:1-12. [PMID: 37972428 DOI: 10.1016/j.vhri.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/18/2023] [Accepted: 09/28/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Alzheimer's disease (AD) has become one of the most prevalent neurodegenerative disorders among the elderly. The global cost of dementia is expected to reach US $2 trillion in 2030. In this systematic review, existing evidence on the cost of dementia specific to AD is appraised. METHODS A comprehensive search was done on 3 databases, namely PubMed, ScienceDirect, and Web of Science, to identify original cost-of-illness studies that only evaluate the economic burden of AD up to August 2022. The risk of bias in the studies was assessed using Consolidated Health Economic Evaluation Reporting Standards 2022 criteria. Cost articles without specifying etiology of AD or those in non-English were excluded. RESULTS Twelve of 5536 studies met the inclusion criteria. The total annual cost of AD per capita ranged from US $468.28 in mild AD to US $171 283.80 in severe AD. The cost of care raised nonlinearly with disease severity. Indirect caregiving cost represented the main contributor to societal cost in community-dwelling patients. When special caregiving accommodation was opted in daily care, it results in cost shifting from indirect cost to direct nonmedical cost. Formal caregiving accommodation caused increase in direct cost up to 67.3% of overall economic burden of the disease. CONCLUSIONS AD exerts a huge economic burden on patients and caregivers. Overall rise of each cost component could be anticipated with disease deterioration. Choice of special caregiving accommodation could reduce caregiver's productivity loss but increase the direct nonmedical expenditure of the disease from societal perspective.
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Affiliation(s)
- Lyn Xuan Tay
- Discipline of Social and Administrative Pharmacy, Universiti Sains Malaysia, Pulau Pinang, Gelugor, Malaysia
| | - Siew Chin Ong
- Discipline of Social and Administrative Pharmacy, Universiti Sains Malaysia, Pulau Pinang, Gelugor, Malaysia.
| | - Lynn Jia Tay
- School of International Education, An Hui Medical University, He Fei, An Hui, China
| | - Trecia Ng
- West China School of Medicine, Si Chuan University, Cheng Du, Si Chuan, China
| | - Thaigarajan Parumasivam
- Discipline of Pharmaceutical Technology, Universiti Sains Malaysia, Pulau Pinang, Gelugor, Malaysia
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Chen AC, Epstein AM, Joynt Maddox KE, Grabowski DC, Orav EJ, Barnett ML. Impact of dementia special care units for short-stay nursing home patients. J Am Geriatr Soc 2024; 72:767-777. [PMID: 38041834 PMCID: PMC10947952 DOI: 10.1111/jgs.18708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/19/2023] [Accepted: 11/14/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Improving quality of care provided to short-stay patients with dementia in nursing homes is a policy priority. However, it is unknown whether dementia-focused care strategies are associated with improved clinical outcomes or lower utilization and costs for short-stay dementia patients. METHODS We performed a national survey of nursing home administrators in 2020-2021, asking about the presence of three dementia-focused care services used for their short-stay patients: (1) a dementia care unit, (2) cognitive deficiency training for staff, and (3) dementia-specific occupational therapy. Using Medicare claims, we identified short-stay episodes for beneficiaries residing in surveyed skilled nursing facilities (SNFs) with and without dementia. We compared clinical, cost, and utilization outcomes for dementia patients in SNFs, which did and did not offer dementia-focused care services. As a counterfactual control, we compared these differences to those for non-dementia patients in the same facilities. Our primary quantity of interest was an interaction term between a patients' dementia status and the presence of a dementia-focused care tool. RESULTS The study population included 102,860 Medicare episodes of care from 377 SNF survey respondents in 2018-2019. In adjusted comparisons of the interaction between dementia status and the presence of each dementia-focused care tool, dementia care units were associated with a 1.5-day increase in healthy days at home in the 90 days following discharge (p = 0.01) and a 3.1% decrease in the likelihood of a subsequent SNF admission (p = 0.001). Cognitive deficiency training was also associated with a 2.0% increase in antipsychotics (p = 0.03), whereas dementia-specific occupational therapy was associated with a 1.2% increase in falls (p = 0.01) per patient episode. CONCLUSIONS Self-reported use of dementia care units for short-stay patients was associated with modestly better performance in some, but not all, outcome measures. This provides hypothesis-generating evidence that dementia care units could be a promising mechanism to improve care delivery in nursing homes.
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Affiliation(s)
- Amanda C Chen
- Harvard Graduate School of Arts and Sciences, Cambridge, Massachusetts, USA
| | - Arnold M Epstein
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Karen E Joynt Maddox
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine and Center for Advancing Health Services, Policy and Economics Research, Institute of Public Health at Washington University, St. Louis, Missouri, USA
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - E John Orav
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael L Barnett
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Bhattacharyya KK, Molinari V, Peterson L, Fauth EB, Andel R. Do nursing homes with a higher proportion of residents with dementia have greater or fewer complaints? Aging Ment Health 2024; 28:448-456. [PMID: 37921356 DOI: 10.1080/13607863.2023.2277265] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023]
Abstract
Objectives: Nursing home (NH) residents' capacity to communicate deteriorates with dementia. Consequently, NHs with high proportions of people living with dementia (PLWD) may receive fewer resident complaints, and/or investigating complaints may be challenging. We assessed NHs' proportion of PLWD in relation to total and substantiated complaints. Methods: Data were from the ASPEN Complaints/Incident Tracking System and the Certification and Survey Provider Enhanced Reports (2017). NHs (N = 15,499) were categorized based on high (top-10%), medium (middle-80%), and low (bottom-10%) dementia prevalence. Negative binomial Poisson regression assessed complaint patterns in relation to NHs' high/low (vs. medium) proportions of PLWD and other facility/resident characteristics. Results: Compared to NHs with medium-dementia prevalence, NHs with low proportions of PLWD had higher total (average marginal effect [AME] = 0.16, p < 0.001) and substantiated (AME = 0.30, p < 0.001) complaints, whereas NHs with high proportions of PLWD had fewer total (AME= -0.07; p < 0.05) and substantiated (AME= -0.11, p < 0.05) complaints. Also, NHs' profit status, chain-affiliation, size, staffing, and resident ethnicity were associated with total and substantiated complaints. Conclusion: The association between high proportions of PLWD and lower NH complaints suggests either that these NHs have higher overall quality or that complaints are underreported. Regardless, surveyors and families may need more involvement in monitoring higher dementia prevalence facilities.
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Affiliation(s)
| | - Victor Molinari
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Lindsay Peterson
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Elizabeth B Fauth
- Alzheimer's Disease and Dementia Research Center, Utah State University, Logan, UT, USA
- Department of Human Development and Family Studies, Utah State University, Logan, UT, USA
| | - Ross Andel
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
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Chan WC, Wang WF, Tung YC, Chang MC, Chan HT, Jhang KM. Influence of care modes and social resources on psychotropic medication use in community-dwelling dementia patients. Front Psychiatry 2024; 14:1196801. [PMID: 38293597 PMCID: PMC10824929 DOI: 10.3389/fpsyt.2023.1196801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 12/26/2023] [Indexed: 02/01/2024] Open
Abstract
Background Optimal use of psychotropic medications for people living with dementia is important. By finding potentially modifiable factors, dementia care teams may find solutions to achieve the appropriate use of psychotropic drugs. Objective This study aimed to elucidate patient and caregiver factors associated with the use of psychotropic drugs listed in the potentially inappropriate medications (PIMs) in community-dwelling people with dementia. Methods This cross-sectional study enrolled 808 patients newly diagnosed with dementia, and their caregivers, from a dementia clinic at Changhua Christian Hospital. Patient and caregiver characteristics, care mode, and social resource usage were recorded. Multivariate logistic regression was used to identify factors associated with prescribing psychotropic medications. Results Of all the participants, 39.1% used at least one of psychotropic medication categorized as PIM. Patients with frontotemporal dementia, with behavior or psychological symptoms, or cared by sole foreign care workers; caregivers with higher depression scores, employed or non-spouse caregivers carried a higher risk of prescription of psychotropic medications listed in PIMs. Conclusion Psychotropic drug prescriptions are associated with patient and caregiver factors. Therefore, implementing appropriate interventions, especially those targeting potentially modifiable factors, is important to reduce psychotropic medication use.
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Affiliation(s)
- Wei-Chieh Chan
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Wen-Fu Wang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Yu-Chun Tung
- Department of Pharmacy, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Che Chang
- Department of Nuclear Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Hong-Ting Chan
- Department of Long-Term Care Medicine, Puli Christian Hospital, Nantou, Taiwan
| | - Kai-Ming Jhang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
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Mukamel DB, Ladd H, Saliba D, Konetzka RT. Dementia, nurse staffing, and health outcomes in nursing homes. Health Serv Res 2023. [PMID: 38156513 DOI: 10.1111/1475-6773.14270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVE To estimate and contrast the relationships between nurse staffing and health outcomes in nursing homes with low and high dementia census, to understand the association of staffing hours with dementia care quality. DATA SOURCES AND STUDY SETTING A national sample of nursing homes during 2017-2019 (pre-COVID). Data included the Payroll-Based Journal, Medicare Claims, Nursing Home Care Compare, and Long-Term Care Focus. STUDY DESIGN Retrospective, regression analyses. We estimated separate linear models predicting six long-term facility-level outcomes. Independent variables included staffing hours per resident-day (HPRD) interacted with the facility percentage of dementia residents, controlling for other resident and facility characteristics. DATA COLLECTION/EXTRACTION METHODS Hospital-based nursing homes, those with fewer than 30% dementia residents, and missing data were excluded. PRINCIPAL FINDINGS We found that registered nurses and certified nurse assistants HPRDs were likely to exhibit positive returns in terms of outcomes throughout most of the range of HPRD for both high and low-census dementia facilities, although, high- and low-dementia facilities differed in most outcome rates at all staffing levels. Average predicted antipsychotics and activities of daily living as functions of HPRD were worse in higher dementia facilities, independent movement, and hospitalizations did not differ significantly, and Emergency Rooms and pressure sores were worse in lower dementia facilities. Average marginal effects were not statistically different [CI included zero] between the high and low dementia facilities for any outcome. CONCLUSIONS These findings suggest that increasing staffing will improve outcomes by similar increments in both low- and high-dementia facilities for all outcomes. However, at any given level of staffing, absolute differences in outcomes between low- and high-dementia facilities remain, suggesting that additional staffing alone will not suffice to close these gaps. Further studies are required to identify opportunities for improvement in performance for both low- and high-dementia census facilities.
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Affiliation(s)
- Dana B Mukamel
- Department of Medicine, Division of General Internal Medicine, University of California, Irvine, California, USA
- Department of Medicine, iTEQC Research Program, University of California, Irvine, California, USA
| | - Heather Ladd
- Department of Medicine, iTEQC Research Program, University of California, Irvine, California, USA
| | - Debra Saliba
- Los Angeles Borun Center at David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Veterans Administration GRECC, Los Angeles, California, USA
- RAND Health, Santa Monica, California, USA
| | - R Tamara Konetzka
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
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Hsi JB, Singh RD, Pedroza R, Gussin GM, Tjoa TT, Gohil SK. Impact of Alzheimer's disease and related dementias (ADRD) on the quality of room cleaning in nursing homes. Infect Control Hosp Epidemiol 2023; 44:1508-1510. [PMID: 36756757 DOI: 10.1017/ice.2023.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Persons with Alzheimer's disease and related dementias (ADRD) are prone to receiving reduced quality of care. We compared the quality of room cleaning of rooms with ADRD residents and rooms with non-ADRD residents in nursing homes using an ultraviolet (UV) marker. ADRD status was associated with greater failure of UV marker removal (odds ratio, 1.68; 95% confidence interval, 1.04-2.71; P = .03).
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Affiliation(s)
- Joshua B Hsi
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California
| | - Raveena D Singh
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California
| | - Robert Pedroza
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California
| | - Gabrielle M Gussin
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California
| | - Thomas T Tjoa
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California
| | - Shruti K Gohil
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California
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Verderber S, Koyabashi U, Cruz CD, Sadat A, Anderson DC. Residential Environments for Older Persons: A Comprehensive Literature Review (2005-2022). HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:291-337. [PMID: 37078127 PMCID: PMC10328148 DOI: 10.1177/19375867231152611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND Independent noninstitutional and institutional residential long-term care environments for older persons have been the subject of significant empirical and qualitative research in the 2005-2022 period. A comprehensive review of this literature is reported, summarizing recent advancements in this rapidly expanding body of knowledge. PURPOSE AND AIM This comprehensive review conceptually structures the recent literature on environment and aging to provide conceptual clarity and identify current and future trends. METHOD AND RESULT Each source reviewed was classified as one of the five types-opinion piece/essay, cross-sectional empirical investigation, nonrandomized comparative investigation, randomized study, and policy review essay-within eight content categories: community-based aging in place; residentialism; nature, landscape, and biophilia; dementia special care units; voluntary/involuntary relocation; infection control/COVID-19, safety/environmental stress; ecological and cost-effective best practices; and recent design trends and prognostications. CONCLUSIONS Among the findings embodied in the 204 literature sources reviewed, all-private room long-term care residential units are generally safer and provide greater privacy and personal autonomy to residents, the deleterious impacts of involuntary relocation continue, family engagement in policy making and daily routines has increased, multigenerational independent living alternatives are increasing, the therapeutic role of nature and landscape is increasingly well-documented, ecological sustainability has increased in priority, and infection control measures are of high priority in the wake of the coronavirus pandemic. Discussion of the results of this comprehensive review sets the stage for further research and design advancements on this subject in light of the rapid aging of societies around the globe.
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Affiliation(s)
- Stephen Verderber
- Centre for Design + Health Innovation, John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Umi Koyabashi
- Centre for Design + Health Innovation, John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
| | - Catherine Dela Cruz
- John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
| | - Aseel Sadat
- John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
| | - Diana C. Anderson
- Boston University School of Medicine, MA, USA
- Jacobs, Dallas, TX, USA
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Mukamel DB, Saliba D, Ladd H, Konetzka RT. Dementia Care Is Widespread In US Nursing Homes; Facilities With The Most Dementia Patients May Offer Better Care. Health Aff (Millwood) 2023; 42:795-803. [PMID: 37276482 PMCID: PMC10796080 DOI: 10.1377/hlthaff.2022.01263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
More than three million US nursing home residents were diagnosed with Alzheimer's disease and related dementias (ADRD) between 2017 and 2019. This number is expected to increase as the population ages and ADRD prevalence increases. People with ADRD require specialized care from trained staff. This study addressed two questions: Are residents with ADRD concentrated in nursing homes where they are the majority? If not, what are the implications for their quality of care and life? We answered the first question by determining the ADRD census for each nursing home in the country during the period 2017-19. Using the Minimum Data Set and Medicare claims, we compared characteristics of nursing homes with high and low ADRD census along several dimensions, including staffing, resident outcomes, and resident characteristics. We found that residents with ADRD were dispersed throughout all nursing homes, with fewer than half residing in nursing homes where residents with ADRD accounted for 60-90 percent of the census. Furthermore, only facilities exceeding 90 percent of residents with ADRD seemed to offer better care. These findings raise concerns about the quality of care and life for the majority of residents with ADRD, suggesting that current National Institutes of Health dementia research initiatives and the Biden administration's policies to improve nursing home care should be coordinated.
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Affiliation(s)
- Dana B Mukamel
- Dana B. Mukamel , University of California Irvine, Irvine, California
| | - Debra Saliba
- Debra Saliba, University of California Los Angeles and Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
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Hendricksen M, Mitchell SL, Lopez RP, Mazor KM, McCarthy EP. Facility Characteristics Associated With Intensity of Care of Nursing Homes and Hospital Referral Regions. J Am Med Dir Assoc 2022; 23:1367-1374. [PMID: 34826394 PMCID: PMC9124728 DOI: 10.1016/j.jamda.2021.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/20/2021] [Accepted: 10/23/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Intensity of care, such as hospital transfers and tube feeding of residents with advanced dementia varies by nursing home (NH) within and across regions. Little work has been done to understand how these 2 levels of influence relate. This study's objectives are to identify facility factors associated with NHs providing high-intensity care to residents with advanced dementia and determine whether these factors differ within and across hospital referral regions (HRRs). DESIGN Cross-sectional analysis. SETTING AND PARTICIPANTS 1449 NHs. METHODS Nationwide 2016-2017 Minimum Data Set was used to categorize NHs and HRRs into 4 levels of care intensity based on rates of hospital transfers and tube feeding among residents with advanced dementia: low-intensity NH in a low-intensity HRR, high-intensity NH in a low-intensity HRR, low-intensity NH in a high-intensity HRR, and a high-intensity NH in a high-intensity HRR. RESULTS In high-intensity HRRs, high-vs low-intensity NHs were more likely to be urban, lack a dementia unit, have a nurse practitioner or physician (NP or PA) on staff, and have a higher proportion of residents who were male, aged <65 years, Black, had pressure ulcers, and shorter hospice stays. In low-intensity HRRs, higher proportion of Black residents was the only characteristic associated with being a high-intensity NH. CONCLUSIONS AND IMPLICATIONS These findings suggest that within high-intensity HRRs, there are potentially modifiable factors that could be targeted to reduce burdensome care in advanced dementia, including having a dementia unit, palliative care training for NPs and PAs, and increased use of hospice care.
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Affiliation(s)
- Meghan Hendricksen
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
| | - Susan L Mitchell
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Kathleen M Mazor
- Meyers Primary Care Institute, Worcester, MA, USA; Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Ellen P McCarthy
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Lapane KL, Dubé CE, Jesdale BM, Bova C. Social Connectedness among Long-Stay Nursing Home Residents with Alzheimer's and Dementia: Exploring Individual and Facility-Level Variation. Dement Geriatr Cogn Disord 2022; 51:249-261. [PMID: 35785759 PMCID: PMC9501789 DOI: 10.1159/000525343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/13/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION This study sought to explore individual and facility-level variation in social connectedness among long-stay nursing home residents with Alzheimer's or other dementias (ADRD). METHODS We identified 721,074 long-stay residents with ADRD using 2016 Minimum Data Set 3.0 data. Social connectedness was defined using the social connectedness index (SCI) (high: SCI = 5, lower: 0 < SCI ≤ 4). Adjusted odds ratios (aOR) provided estimates of the associations between resident-level and facility-level characteristics, and high SCI was derived from logistic models. RESULTS The SCI Cronbach's alpha was 0.69; 78.6% had high SCI scores. Men were less likely than women to have higher SCI scores (aOR = 0.97; 95% CI: 0.97-0.98). Increasing age was associated with higher SCI scores (e.g., aOR [85-94 vs. 40-64 years]: 1.07; 95% CI: 1.06-1.07). Those with moderate cognitive impairment (aOR: 0.87) and severe cognitive impairment (aOR: 0.85) had reduced odds of SCI = 5 relative to those with mild/intact cognitive function. Residents living in homes with special care dementia units and with higher percentage of residents with dementia had decreased odds of high social connectedness. DISCUSSION/CONCLUSION Understanding resident- and nursing home-level variation in social connectedness may be important for targeting interventions that reduce isolation among residents with ADRD.
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Affiliation(s)
- Kate L. Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA,*Kate L. Lapane,
| | - Catherine E. Dubé
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Bill M. Jesdale
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Carol Bova
- Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, Massachusetts, USA
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Abstract
BACKGROUND Dementia is a life-limiting condition that affects 50 million people globally. Existing definitions of end of life do not account for the uncertain trajectory of dementia. People living with dementia may live in the advanced stage for several years, or even die before they reach the advanced stage of dementia. AIM To identify how end of life in people with dementia is measured and conceptualised, and to identify the factors that contribute towards identifying end of life in people with dementia. DESIGN Systematic review and narrative synthesis. DATA SOURCES Electronic databases MEDLINE, EMBASE, PsychInfo and CINAHL, were searched in April 2020. Eligible studies included adults with any dementia diagnosis, family carers and healthcare professionals caring for people with dementia and a definition for end of life in dementia. RESULTS Thirty-three studies met the inclusion criteria. Various cut-off scores from validated tools, estimated prognoses and descriptive definitions were used to define end of life. Most studies used single measure tools which focused on cognition or function. There was no pattern across care settings in how end of life was defined. Healthcare professionals and family carers had difficulty recognising when people with dementia were approaching the end of life. CONCLUSION End-of-life care and research that focuses only on cognitive and functional decline may fail to recognise the complexities and unmet needs relevant to dementia and end of life. Research and clinical practice should adopt a needs-based approach for people with dementia and not define end of life by stage of disease.
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Affiliation(s)
- Bria Browne
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Kirsten J Moore
- Marie Curie Palliative Care Research Department, University College London, London, UK
- National Ageing Research Institute, Parkville, Victoria, Australia
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, University College London, London, UK
- Barnet, Enfield and Haringey Mental Health Trust, North Middlesex University Hospital, London, UK
| | - Nathan Davies
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
- Marie Curie Palliative Care Research Department, University College London, London, UK
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Palm R, Fahsold A, Roes M, Holle B. Context, mechanisms and outcomes of dementia special care units: An initial programme theory based on realist methodology. PLoS One 2021; 16:e0259496. [PMID: 34784375 PMCID: PMC8594822 DOI: 10.1371/journal.pone.0259496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 10/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background Dementia special care units represent a widely implemented care model in nursing homes. Their benefits must be thoroughly evaluated given the risk of exclusion and stigma. The aim of this study is to present an initial programme theory that follows the principles of realist methodology. The theory development was guided by the question of the mechanisms at play in the context of dementia special care units to produce or influence outcomes of interest in people with dementia. Methods The initial programme theory is based on qualitative interviews with dementia special care stakeholders in Germany and a realist review of complex interventions in dementia special care units. The interviews were analysed using content analysis techniques. For the realist review, a systematic literature search was conducted in four scientific databases; studies were appraised for quality and relevance. All data were analysed independently by two researchers. A realist informed logic model was developed, and context-mechanism-outcome (CMO) configurations were described. Results We reviewed 16 empirical studies and interviewed 16 stakeholders. In the interviews, contextual factors at the system, organisation and individual levels that influence the provision of care in dementia special care units were discussed. The interviewees described the following four interventions typical of dementia special care units: adaptation to the environment, family and public involvement, provision of activities and behaviour management. With exception of family and public involvement, these interventions were the focus of the reviewed studies. The outcomes of interest of stakeholders include responsive behaviour and quality of life, which were also investigated in the empirical studies. By combining data from interviews and a realist review, we framed three CMO configurations relevant to environment, activity, and behaviour management. Discussion As important contextual factors of dementia special care units, we discuss the transparency of policies to regulate dementia care, segregation and admission policies, purposeful recruitment and education of staff and a good fit between residents and their environment.
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Affiliation(s)
- Rebecca Palm
- Faculty of Health, Witten/Herdecke University, School of Nursing Science, Witten, Germany
- * E-mail:
| | - Anne Fahsold
- Faculty of Health, Witten/Herdecke University, School of Nursing Science, Witten, Germany
- German Center for Neurodegenerative Diseases, Witten, Germany
| | - Martina Roes
- Faculty of Health, Witten/Herdecke University, School of Nursing Science, Witten, Germany
- German Center for Neurodegenerative Diseases, Witten, Germany
| | - Bernhard Holle
- Faculty of Health, Witten/Herdecke University, School of Nursing Science, Witten, Germany
- German Center for Neurodegenerative Diseases, Witten, Germany
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Brody AA, Barnes DE, Chodosh J, Galvin JE, Hepburn KW, Troxel AB, Hom K, McCarthy EP, Unroe KT. Building a National Program for Pilot Studies of Embedded Pragmatic Clinical Trials in Dementia Care. J Am Geriatr Soc 2021; 68 Suppl 2:S14-S20. [PMID: 32589282 DOI: 10.1111/jgs.16618] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/03/2020] [Accepted: 04/10/2020] [Indexed: 12/24/2022]
Abstract
Sixteen million caregivers currently provide care to more than 5 million persons living with dementia (PLWD) in the United States. Although this population is growing and highly complex, evidence-based management remains poorly integrated within healthcare systems. Therefore, the National Institute on Aging IMPACT Collaboratory was formed to build the nation's ability to conduct embedded pragmatic clinical trials (ePCTs) for PLWD and their caregivers. The pilot core of the IMPACT Collaboratory seeks to provide funds for upward of 40 pilots for ePCTs to accelerate the testing of nonpharmacologic interventions with the goal that these pilots lead to full-scale ePCTs and eventually the embedding of evidence-based care into healthcare systems. The first two challenges for the pilot core in building the pilot study program were (1) to develop a transparent, ethical, and open nationwide process for soliciting, reviewing, and selecting pilot studies; and (2) to begin the process of describing the necessary components of a pilot study for an ePCT. During our initial funding cycle, we received 35 letters of intent, of which 17 were accepted for a full proposal and 14 were submitted. From this process we learned that investigators lack knowledge in ePCTs, many interventions lack readiness for an ePCT pilot study, and many proposed studies lack key pragmatic design elements. We therefore have set three key criteria that future pilot studies must meet at a minimum to be considered viable. We additionally discuss key design decisions investigators should consider in designing a pilot study for an ePCT. J Am Geriatr Soc 68:S14-S20, 2020.
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Affiliation(s)
- Abraham A Brody
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, New York, USA.,Division of Geriatric Medicine and Palliative Care, NYU Grossman School of Medicine, New York, New York, USA
| | - Deborah E Barnes
- Department of Psychiatry and Epidemiology & Biostatistics, University of California, San Francisco School of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, NYU Grossman School of Medicine, New York, New York, USA
| | - James E Galvin
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Andrea B Troxel
- Division of Biostatistics, NYU Grossman School of Medicine, New York, New York, USA
| | - Kimberly Hom
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, New York, USA
| | - Ellen P McCarthy
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen T Unroe
- Center for Aging Research, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
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15
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Orth J, Li Y, Simning A, Zimmerman S, Temkin-Greener H. End-of-Life Care among Nursing Home Residents with Dementia Varies by Nursing Home and Market Characteristics. J Am Med Dir Assoc 2021; 22:320-328.e4. [PMID: 32736989 PMCID: PMC7855379 DOI: 10.1016/j.jamda.2020.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/30/2020] [Accepted: 06/05/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Nursing homes (NHs) are critical end-of-life (EOL) care settings for 70% of Americans dying with Alzheimer's disease/related dementias (ADRD). Whether EOL care/outcomes vary by NH/market characteristics for this population is unknown but essential information for improving NH EOL care/outcomes. Our objectives were to examine variations in EOL care/outcomes among decedents with ADRD and identify associations with NH/market characteristics. DESIGN Cross-sectional. OUTCOMES Place-of-death (hospital/NH), presence of pressure ulcers, potentially avoidable hospitalizations (PAHs), and hospice use at EOL. Key covariates were ownership, staffing, presence of Alzheimer's units, and market competition. SETTING AND PARTICIPANTS Long-stay NH residents with ADRD, age 65 + years of age, who died in 2017 (N = 191,435; 14,618 NHs) in NHs or hospitals shortly after NH discharge. METHODS National Medicare claims, Minimum Data Set, public datasets. Descriptive analyses and multivariable logistic regressions. RESULTS As ADRD severity increased, adjusted rates of in-hospital deaths and PAHs decreased (17.0% to 6.3%; 11.2% to 7.0%); adjusted rates of dying with pressure ulcers and hospice use increased (8.2% to 13.5%; 24.5% to 40.7%). Decedents with moderate and severe ADRD had 16% and 13% higher likelihoods of in-hospital deaths in for-profit NHs. In NHs with Alzheimer's units, likelihoods of in-hospital deaths, dying with pressure ulcers, and PAHs were significantly lower. As ADRD severity increased, higher licensed nurse staffing was associated with 14%‒27% lower likelihoods of PAHs. Increased NH market competition was associated with higher likelihood of hospice use, and lower likelihood of in-hospital deaths among decedents with moderate ADRD. CONCLUSIONS AND IMPLICATIONS Decedents with ADRD in NHs that were nonprofit, had Alzheimer's units, higher licensed nurse staffing, and in more competitive markets, had better EOL care/outcomes. Modifications to state Medicaid NH payments may promote better EOL care/outcomes for this population. Future research to understand NH care practices associated with presence of Alzheimer's units is warranted to identify mechanisms possibly promoting higher-quality EOL care.
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Affiliation(s)
- Jessica Orth
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY.
| | - Yue Li
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Adam Simning
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Sheryl Zimmerman
- The Cecil G. Sheps Center for Health Services Research and The Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
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Ohno S, Chen Y, Sakamaki H, Matsumaru N, Yoshino M, Tsukamoto K. Burden of caring for Alzheimer's disease or dementia patients in Japan, the US, and EU: results from the National Health and Wellness Survey: a cross-sectional survey. J Med Econ 2021; 24:266-278. [PMID: 33538195 DOI: 10.1080/13696998.2021.1880801] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS The growing prevalence of Alzheimer's disease (AD) worldwide has sparked the implementation of national policies to support the growing burden among caregivers of AD/dementia patients. This study aims to quantify and compare the burden of AD/dementia caregivers and evaluate how different living arrangements might impact health outcomes among caregivers in Japan, five European countries (5EU), and the United States (US). MATERIALS AND METHODS This is a cross-sectional study based on existing data from the 2018 National Health and Wellness Survey. Health outcome measures included health-related quality of life (HRQoL), health state utilities, work productivity and activity impairment (WPAI), and measurement of depression and anxiety amongst AD/dementia caregivers and non-caregivers. Pairwise comparisons between AD/dementia caregivers in Japan, 5EU, and the US were conducted. Multivariate analysis was used to compare across groups within each region, with adjustment for potential confounding effects. RESULTS A higher proportion of caregivers of AD/dementia patients in Japan were 65 years or older as compared to 5EU and US. On the contrary, female caregivers were significantly higher in the US than Japan and 5EU. The HRQoL and health state utilities index scores amongst AD/dementia caregivers were highest in Japan and lowest in the US. Caregivers in Japan incurred the lowest WPAI among the three regions. The proportion of AD/dementia patients reportedly living in an institution was highest in Japan as compared to the US and EU. Notably, US caregivers whose patients lived in an institution experienced significantly less caregiving burden as compared to caregivers whose patients lived in the community. CONCLUSIONS The caregiving burden among AD/dementia caregivers was substantial across the three regions, with similarities and differences between the West and Japan. The lower caregiving burden in Japan was potentially associated with national policies supporting long-term healthcare and institutionalized nursing care facilities for AD/dementia patients.
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Affiliation(s)
- Shinya Ohno
- Global Regulatory Science, Gifu Pharmaceutical University, Gifu, Japan
- Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Yirong Chen
- Health Division, Kantar Health Inc., Singapore, Singapore
| | - Hiroyuki Sakamaki
- Graduate School of Health Innovation, Kanagawa University of Human Services, Kawasaki, Japan
| | - Naoki Matsumaru
- Global Regulatory Science, Gifu Pharmaceutical University, Gifu, Japan
| | | | - Katsura Tsukamoto
- Global Regulatory Science, Gifu Pharmaceutical University, Gifu, Japan
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Afonso-Argilés FJ, Meyer G, Stephan A, Comas M, Wübker A, Leino-Kilpi H, Lethin C, Saks K, Soto-Martin M, Sutcliffe C, Verbeek H, Zabalegui A, Renom-Guiteras A. Emergency department and hospital admissions among people with dementia living at home or in nursing homes: results of the European RightTimePlaceCare project on their frequency, associated factors and costs. BMC Geriatr 2020; 20:453. [PMID: 33153444 PMCID: PMC7643440 DOI: 10.1186/s12877-020-01835-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/14/2020] [Indexed: 11/21/2022] Open
Abstract
Background Evidence is lacking on the differences between hospitalisation of people with dementia living in nursing homes and those living in the community. The objectives of this study were: 1) to describe the frequency of hospital admission among people with dementia in eight European countries living in nursing homes or in the community, 2) to examine the factors associated with hospitalisation in each setting, and 3) to evaluate the costs associated with it. Methods The present study is a secondary data analysis of the RightTimePlaceCare European project. A cross-sectional survey was conducted with data collected from people with dementia living at home or who had been admitted to a nursing home in the last 3 months, as well as from their caregivers. Data on hospital admissions at 3 months, cognitive and functional status, neuropsychiatric symptoms, comorbidity, polypharmacy, caregiver burden, nutritional status, and falls were assessed using validated instruments. Multivariate regression models were used to investigate the factors associated with hospital admission for each setting. Costs were estimated by multiplying quantities of resources used with the unit cost of each resource and inflated to the year 2019. Results The study sample comprised 1700 people with dementia living in the community and nursing homes. Within 3 months, 13.8 and 18.5% of people living in nursing homes and home care, respectively, experienced ≥1 hospital admission. In the nursing home setting, only polypharmacy was associated with a higher chance of hospital admission, while in the home care setting, unintentional weight loss, polypharmacy, falls, and more severe caregiver burden were associated with hospital admission. Overall, the estimated average costs per person with dementia/year among participants living in a nursing home were lower than those receiving home care. Conclusion Admission to hospital is frequent among people with dementia, especially among those living in the community, and seems to impose a remarkable economic burden. The identification and establishment of an individualised care plan for those people with dementia with polypharmacy in nursing homes, and those with involuntary weight loss, accidental falls, polypharmacy and higher caregiver burden in the home care setting, might help preventing unnecessary hospital admissions.
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Affiliation(s)
- F Javier Afonso-Argilés
- Department of Geriatric Medicine and Palliative Care. Badalona Serveis Assistencials, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gabriele Meyer
- Department of Nursing Science, Witten/Herdecke University, Witten, Germany. .,Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Astrid Stephan
- Department of Nursing Science, Witten/Herdecke University, Witten, Germany.,Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Mercè Comas
- Department of Epidemiology and Evaluation. Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.,Member of the Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | - Ansgar Wübker
- RWI - Leibniz-Institute for Economic Research, Leibniz Science Campus Ruhr and RUB, Essen, Germany
| | - Helena Leino-Kilpi
- Department of Nursing Science and Nurse Director, Turku University Hospital, University of Turku, Turku, Finland
| | - Connie Lethin
- Department of Health Sciences. Faculty of Medicine, Lund University, SE-221 00, Lund, Sweden.,Clinical Memory Research Unit. Department of Clinical Sciences, Lund University, SE-221 00, Lund, Sweden
| | - Kai Saks
- Department of Internal Medicine, University of Tartu, Tartu, Estonia
| | - Maria Soto-Martin
- Department of Geriatric Medicine, Gerontopole, Alzheimer Disease Research Center, Inserm UMR 1027, University Hospital of Toulouse, Toulouse, France
| | | | - Hilde Verbeek
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Adelaida Zabalegui
- Hospital Clinic de Barcelona, Barcelona, Spain.,School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Anna Renom-Guiteras
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Member of the Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain.,Department of Geriatric Medicine, Parc de Salut Mar, Barcelona, Spain
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18
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Bergmann JM, Ströbel AM, Holle B, Palm R. Empirical development of a typology on residential long-term care units in Germany - results of an exploratory multivariate data analysis. BMC Health Serv Res 2020; 20:646. [PMID: 32652983 PMCID: PMC7353672 DOI: 10.1186/s12913-020-05401-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 06/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Organizational health care research focuses on describing structures and processes in organizations and investigating their impact on the quality of health care. In the setting of residential long-term care, this effort includes the examination and description of structural differences among the organizations (e.g., nursing homes). The objective of the analysis is to develop an empirical typology of living units in nursing homes that differ in their structural characteristics. METHODS Data from the DemenzMonitor Study were used. The DemenzMonitor is an observational study carried out in a convenience sample of 103 living units in 51 nursing homes spread over 11 German federal states. Characteristics of living units were measured by 19 variables related to staffing, work organization, building characteristics and meal preparation. Multiple correspondence analysis (MCA) and agglomerative hierarchical cluster analysis (AHC) are suitable to create a typology of living units. Both methods are multivariate and explorative. We present a comparison with a previous typology (created by a nonexplorative and nonmultivariate process) of the living units derived from the same data set. RESULTS The MCA revealed differences among the living units, which are defined in particular by the size of the living unit (number of beds), the additional qualifications of the head nurse, the living concept and the presence of additional financing through a separate benefit agreement. We identified three types of living units; these clusters occur significantly with a certain combination of characteristics. In terms of content, the three clusters can be defined as: "house community", "dementia special care units" and "usual care". CONCLUSION A typology is useful to gain a deeper understanding of the differences in the care structures of residential long-term care organizations. In addition, the study provides a practical recommendation on how to apply the results, enabling living units to be assigned to a certain type. The typology can be used as a reference for definitions.
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Affiliation(s)
- Johannes Michael Bergmann
- German Centre for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, Witten, North Rhine-Westphalia, 58453, Germany. .,University Witten/Herdecke, Faculty of Health, Department for Nursing Science, Witten, North Rhine-Westphalia, Germany.
| | - Armin Michael Ströbel
- Center for Clinical Studies, University Hospital Erlangen, Krankenhausstraße 12, Erlangen, Bavaria, 91054, Germany
| | - Bernhard Holle
- German Centre for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, Witten, North Rhine-Westphalia, 58453, Germany.,University Witten/Herdecke, Faculty of Health, Department for Nursing Science, Witten, North Rhine-Westphalia, Germany
| | - Rebecca Palm
- German Centre for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, Witten, North Rhine-Westphalia, 58453, Germany.,University Witten/Herdecke, Faculty of Health, Department for Nursing Science, Witten, North Rhine-Westphalia, Germany
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19
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Petersen MS. Assessing the Prevalence of Undetected Possible Dementia in Faroese Nursing Homes. Dement Geriatr Cogn Disord 2020; 48:30-38. [PMID: 31319414 DOI: 10.1159/000501607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/19/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION To assess the prevalence of possible dementia among nursing home residents in the Faroe Islands. METHOD This cross-sectional study, undertaken in 2017, included all nursing homes in the Faroe Islands (n = 30), housing 591 residents. All residents were invited to participate, except those with an existing clinical diagnosis of dementia or living in dementia units (n = 207). A total of 232 residents participated, while 39 declined and 113 were unable to give consent, had died, or were not permanent residents at the time of examination. Cognitive screening was carried out using the Mini-Mental State Examination (MMSE) and the Informant Questionnaire on Cognitive Decline (IQCODE). RESULTS Possible dementia was found in 49% to 78% of the participants depending on the method used. According to both MMSE and IQCODE (AND rule), possible dementia was present in 105 participants (49%). According only to IQCODE, 119 participants (55%) scored above the cut-off (≥3.6), according to MMSE alone, 162 participants (72%) scored below the cut-off (≤24 on MMSE), while 175 participants (78%) screened positive according to either MMSE or IQCODE (OR rule). A rough estimate of the prevalence of possible dementia in the entire nursing home population (n = 591) including residents with known dementia and those with possible dementia from this study was between 61% and 73%. CONCLUSION A high percentage (49-78%) of the participating nursing home residents without a pre-dementia diagnosis were assessed to have possible dementia based on screening with standardized tools, indicating a high degree of dementia underdiagnoses in Faroese nursing homes. This high prevalence of dementia is of significance for the clinical practice, running, and planning of nursing homes and pinpoints a need to act upon this, not only in the Faroes but also worldwide.
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Affiliation(s)
- Maria Skaalum Petersen
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faeroe Islands, .,Faculty of Health Sciences, Centre of Health Science, University of the Faroe Islands, Tórshavn, Faeroe Islands,
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20
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Kok JS, Oude Voshaar RC, Scherder EJA. Psychotropic drug use in residents with dementia living in small-scaled special care facilities; a longitudinal study. Aging Ment Health 2020; 24:689-696. [PMID: 30835505 DOI: 10.1080/13607863.2019.1584784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Over the past decade, a trend has been noticed in the Netherlands to replace large-scaled special care units (SCUs) caring for 20-30 residents with dementia by small-scaled SCUs caring for up to 8 residents. Systematic evaluations, however, have yielded a differentiated picture of the effects. As the impact on psychotropic drug use has hardly been addressed thus far, we examined the (potential) impact of psychotropic drug use when moving residents with dementia from large-scaled to small-scaled SCUs.Methods: We conducted a non-randomized, controlled study with a six-month follow-up. Among 145 residents with dementia living a large-scaled SCUs for dementia caring for 20-30 residents per unit, a total of 77 residents were moved to small-scaled SCUs caring for up to 8 residents per unit. Psychotropic drug use, classified according to the Anatomical Therapeutic Chemical Classification (ATC) system was monitored at 2 months before replacement, as well as at 3 and 6 months thereafter. Repeated measures ANOVAs were conducted for the mean Defined Daily Doses (DDDs) of both groups.Results: No significant differences between both groups in psychotropic medication use were found over a period of 8 months.Conclusion: Prescription of psychotropic drugs does not change after a transfer from a large-scaled SCU to a small-scaled SCU of patients with moderate to severe dementia.Current Controlled Trials: ISRCTN11151241.
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Affiliation(s)
- Jeroen S Kok
- Lentis
- Dignis, Mental Health Care Institute, Zuidlaren, The Netherlands
| | - Richard C Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erik J A Scherder
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
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21
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Palm R, Trutschel D, Sorg CGG, Dichter MN, Haastert B, Holle B. Quality of Life in People With Severe Dementia and Its Association With the Environment in Nursing Homes: An Observational Study. THE GERONTOLOGIST 2020; 59:665-674. [PMID: 29566150 DOI: 10.1093/geront/gny017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Theoretical models propose the environment as a factor influencing the quality of life (QoL) of nursing home residents with dementia. This study investigates whether the observed QoL differs depending on the type of care unit. RESEARCH DESIGN AND METHODS DemenzMonitor is an exploratory, observational study involving annual data collection in German nursing homes (2012-2014). For this analysis, we selected residents with a recorded diagnosis of dementia and severe cognitive impairment. QoL was measured with the proxy assessment QUALIDEM. Four care unit types were investigated: large integrated, large segregated, small integrated, and small segregated. RESULTS We did not find a significant difference between the care units. During the 2 years, the observed QoL was not affected by any of the care unit types in a statistically significant or clinically relevant manner. However, a significant interaction effect between time and care unit types was found. DISCUSSION AND IMPLICATIONS Structural and organizational characteristics of care units, which in turn have implications for residents characteristics and the quality of care, may influence the QoL of residents. This may explain the interaction we observed.
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Affiliation(s)
- Rebecca Palm
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany.,School of Nursing Science, University Witten/Herdecke, Germany
| | - Diana Trutschel
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany.,Institute of Informatics, Martin-Luther University Halle/Wittenberg, Halle/Saale, Germany
| | - Christian G G Sorg
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany.,School of Nursing Science, University Witten/Herdecke, Germany
| | - Martin N Dichter
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany.,School of Nursing Science, University Witten/Herdecke, Germany
| | | | - Bernhard Holle
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany.,School of Nursing Science, University Witten/Herdecke, Germany
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Effect of an Educational and Organizational Intervention on Pain in Nursing Home Residents: A Nonrandomized Controlled Trial. J Am Med Dir Assoc 2019; 19:1118-1123.e2. [PMID: 30471802 DOI: 10.1016/j.jamda.2018.09.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/20/2018] [Accepted: 09/25/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To determine whether an intervention based on education and professional support to nursing home (NH) staff would decrease the number of residents with a pain complaint, and to determine whether the intervention would improve pain management. DESIGN Nonrandomized controlled trial. NHs were nonrandomly allocated either to a strong intervention group consisting in audit, feedback, and collaborative work on quality indicators with a hospital geriatrician, or to a light intervention group (LIG) consisting in audit and feedback only. SETTING One hundred fifty-nine NHs located in France. PARTICIPANTS A subgroup of 3722 residents. MEASURES Information on pain complaint and pain-related covariates at the resident-related and at the NH level were recorded by NH staff at baseline and 18 months later. These covariates were included in a mixed-effects logistic regression on resident's pain complaint. Pain management was compared between intervention groups by chi-square tests. RESULTS A greater reduction of residents with a pain complaint after the strong intervention (odds ratio 0.69, 95% confidence interval 0.53, 0.90) and a better pain management (47.6% gold standard, vs 30.6% in the LIG, P < .001) than controls. CONCLUSION/IMPLICATIONS Combining educational and organizational measures, evaluating pain as a patient-reported outcome and as a process endpoint, and implementing a broad-spectrum intervention were original approaches to improve quality of care in NHs. Our results support nonspecific, collaborative, educational, and organizational interventions in NHs to decrease residents' pain complaint and improve pain management.
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Perfect D, Griffiths AW, Vasconcelos Da Silva M, Lemos Dekker N, McDermid J, Surr CA. Collecting self-report research data with people with dementia within care home clinical trials: Benefits, challenges and best practice. DEMENTIA 2019; 20:148-160. [PMID: 31466468 DOI: 10.1177/1471301219871168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
One-third of people with dementia live in care home settings and in order to deliver better evidence-based care, robust research including clinical trials is required. Concerns have been raised by researchers about the capacity of care home residents with dementia to participate in clinical trials. This includes self-report measures, completion of which researchers have suggested may be unreliable or impossible and may cause distress for residents. Many trials, therefore, utilise only proxy completed outcome measures. This is despite evidence that individuals with mild through to advanced dementia can reliably report on outcomes, if appropriate measures and approaches to data collection are used. However, little has been written about best practice in data collection with this group. This study aimed to explore the experiences of researchers working on dementia trials in care homes and identify best practices to assist design of future trials. Thirty-three researchers completed an online, qualitative questionnaire outlining their experiences and the perceived benefits and challenges of data collection with people with dementia. We identified five main benefits: (1) improving the delivery of person-centred care, (2) hearing the voice of people with dementia, (3) residents spending time with researchers, (4) improving researcher understanding, and (5) having an evidence base from multiple sources. We also identified five main challenges: (1) effective communication, (2) fluctuating capacity, (3) causing distress to residents, (4) time pressures, and (5) staff availability. Researchers also made suggestions about how these can be overcome. We recommend that the challenges identified could be overcome using appropriate methods for collecting data. Thorough training for researchers on data collection with people with dementia was identified as important for ensuring successful data collection.
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Affiliation(s)
| | - Alys W Griffiths
- Centre for Dementia Research, Leeds Beckett University, Leeds, UK
| | | | - Natashe Lemos Dekker
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam; Leiden University Medical Center (LUMC), the Netherlands
| | - Joanne McDermid
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK
| | - Claire A Surr
- Centre for Dementia Research, Leeds Beckett University, Leeds, UK
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Calkins MP. From Research to Application: Supportive and Therapeutic Environments for People Living With Dementia. THE GERONTOLOGIST 2018; 58:S114-S128. [PMID: 29361065 DOI: 10.1093/geront/gnx146] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Indexed: 11/12/2022] Open
Abstract
The evidence about the role the designed and built environment plays in supporting individuals living with dementia has been steadily mounting for almost 40 years. Beginning with the work of M. Powell Lawton at the Weiss Pavilion at the Philadelphia Geriatric Center, there are now dozens of researchers who are exploring how the environment can be either supportive and therapeutic, indeed even serving as a prosthetic for various changes in cognition, or be a barrier to independent functioning and high quality of life. Two recent literature reviews published on the impact of environmental factors and characteristics on individuals living with dementia clearly delineate evidence that the environment can have a therapeutic or a debilitating impact on individuals living with dementia. Rather than duplicate these excellent reviews, this article puts the knowledge gleaned from this research into the shifting context that is long-term care. This article begins with an exploration of the evolution of approaches to the design of spaces for individuals living with dementia from traditional or medical models, to special care units (SCUs), to person-centered care (PCC), which is the organizing theme of this supplemental issue. A novel, person-centered way of conceptualizing the domains of environmental systems is then presented and used as the framework for structuring recommendations and creating supportive and therapeutic environments for individuals living with dementia. Although there are distinct pathophysiological and behavioral manifestations of different forms of dementia, there is almost no evidence that suggests alternative environmental characteristics are better for one type of dementia over another. Thus, this article will refer to "individuals living with dementia" as opposed to Alzheimer's disease or other specific forms of dementia. Further, this article only addresses residential environments: homes in the community, independent and assisted living residences and nursing homes. It does not address other settings, such as hospitals or hospice, or work and public community spaces, such as stores. It is recognized that individuals living with dementia do spend time in all these spaces, and fortunately, there is growing interest in creating more dementia-friendly communities, but they will not be addressed in this article. Most of the research that has been done has focused on shared residential settings, so that will be the primary focus on this article.
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Joyce NR, McGuire TG, Bartels SJ, Mitchell SL, Grabowski DC. The Impact of Dementia Special Care Units on Quality of Care: An Instrumental Variables Analysis. Health Serv Res 2018; 53:3657-3679. [PMID: 29736944 DOI: 10.1111/1475-6773.12867] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To compare the quality of care following admission to a nursing home (NH) with and without a dementia special care unit (SCU) for residents with dementia. DATA SOURCES/STUDY SETTING National resident-level minimum dataset assessments (MDS) 2005-2010 merged with Medicare claims and provider-level data from the Online Survey, Certification, and Reporting database. STUDY DESIGN We employ an instrumental variable approach to address the endogeneity of selection into an SCU facility controlling for a range of individual-level covariates. We use "differential distance" to a nursing home with and without an SCU as our instrument. DATA COLLECTION/EXTRACTION METHODS Minimum dataset assessments performed at NH admission and every quarter thereafter. PRINCIPAL FINDINGS Admission to a facility with an SCU led to a reduction in inappropriate antipsychotics (-9.7 percent), physical restraints (-9.6 percent), pressure ulcers (-3.3 percent), feeding tubes (-8.3 percent), and hospitalizations (-14.7 percent). We found no impact on the use of indwelling urinary catheters. Results held in sensitivity analyses that accounted for the share of SCU beds and the facilities' overall quality. CONCLUSIONS Facilities with an SCU provide better quality of care as measured by several validated quality indicators. Given the aging population, policies to promote the expansion and use of dementia SCUs may be warranted.
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Affiliation(s)
- Nina R Joyce
- Department of Health Services Policy and Practice, Brown School of Public Health, Brown University School of Public Health, Providence, RI.,Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Thomas G McGuire
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Stephen J Bartels
- Department of Psychiatry, Community and Family Medicine, The Dartmouth Institute, Hanover, NH.,Dartmouth Centers for Health and Aging, Geisel School of Medicine at Dartmouth, Hanover, NH.,New Hampshire-Dartmouth Psychiatric Research Center, Hanover, NH
| | - Susan L Mitchell
- Hebrew Senior Life Institute for Aging Research, Boston, MA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, MA
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Rivera-Hernandez M, Kumar A, Epstein-Lubow G, Thomas KS. Disparities in Nursing Home Use and Quality Among African American, Hispanic, and White Medicare Residents With Alzheimer's Disease and Related Dementias. J Aging Health 2018; 31:1259-1277. [PMID: 29717902 DOI: 10.1177/0898264318767778] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This article examines differences in nursing home use and quality among Medicare beneficiaries, in both Medicare Advantage and fee-for-service, newly admitted to nursing homes with Alzheimer's disease and related dementias (ADRD). Method: Retrospective, national, population-based study of Medicare residents newly admitted to nursing homes with ADRD by race and ethnic group. Our analytic sample included 1,302,099 nursing home residents-268,181 with a diagnosis of ADRD-in 13,532 nursing homes from 2014. Results: We found that a larger share of Hispanic Medicare residents that are admitted to nursing homes have ADRD compared with African American and White beneficiaries. Both Hispanics and African Americans with ADRD received care in segregated nursing homes with fewer resources and lower quality of care compared with White residents. Discussion: These results have implications for targeted efforts to achieve health care equity and quality improvement efforts among nursing homes that serve minority patients.
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Affiliation(s)
| | | | - Gary Epstein-Lubow
- 1 Brown University, Providence, RI, USA.,2 Center for Alzheimer's Disease and Memory Care Hebrew SeniorLife, Boston, MA, USA
| | - Kali S Thomas
- 1 Brown University, Providence, RI, USA.,3 Providence VA Medical Center, RI, USA
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Griffiths AW, Surr CA, Creese B, Garrod L, Chenoweth L. The development and use of the assessment of dementia awareness and person-centred care training tool in long-term care. DEMENTIA 2018; 18:3059-3070. [DOI: 10.1177/1471301218768165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Policy and practice guidelines recommend person-centred care to support people to live well with dementia in long-term care. Therefore, staff working in long-term care settings need to be trained in dementia awareness and person-centred care. However, the access to, content of and reach of training across long-term care settings can be varied. Data on current and ongoing access to person-centred care training can form an important component of data gathered on usual care in research studies, in particular clinical trials within long-term care. However, no suitable assessment tools are available to measure dementia awareness and person-centred care training availability, content and reach. This paper describes the development of a training audit tool to meet this need for a usual care measure of dementia awareness and person-centred care training. The ‘Assessment of Dementia Awareness and Person-centred care Training’ tool was based on a review of published person-centred care literature and consultation with dementia and aged care experts. The Assessment of Dementia Awareness and Person-centred care Training tool was piloted in 13 long-term care facilities the UK and Australia, before being used to assess the content of dementia and person-centred care awareness training in 50 UK settings in a randomized controlled trial as part of usual care recording. Following pilot testing, modifications to the Assessment of Dementia Awareness and Person-centred care Training tool’s wording were made to enhance item clarity. When implemented in the randomized controlled trial, pre-baseline training assessment data showed that the Assessment of Dementia Awareness and Person-centred care Training tool was able to differentiate between the training in different long-term care settings and identify settings where further dementia awareness training was required. The Assessment of Dementia Awareness and Person-centred care Training tool was then used as a method of recording data on dementia awareness and person-centred care training as part of ongoing usual care data collection. The Assessment of Dementia Awareness and Person-centred care Training tool is suitable for use by researchers to establish the availability, content and reach of dementia and person-centred care awareness training to staff within research studies.
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Affiliation(s)
| | - Claire A Surr
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Byron Creese
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Lucy Garrod
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Lynn Chenoweth
- Centre for Healthy Brain Ageing, University of New South Wales, Australia
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Kok JS, Nielen MMA, Scherder EJA. Quality of life in small-scaled homelike nursing homes: an 8-month controlled trial. Health Qual Life Outcomes 2018; 16:38. [PMID: 29486788 PMCID: PMC5830070 DOI: 10.1186/s12955-018-0853-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 01/24/2018] [Indexed: 01/20/2023] Open
Abstract
Background Quality of life is a clinical highly relevant outcome for residents with dementia. The question arises whether small scaled homelike facilities are associated with better quality of life than regular larger scale nursing homes do. Methods A sample of 145 residents living in a large scale care facility were followed over 8 months. Half of the sample (N = 77) subsequently moved to a small scaled facility. Quality of life aspects were measured with the QUALIDEM and GIP before and after relocation. Results We found a significant Group x Time interaction on measures of anxiety meaning that residents who moved to small scale units became less anxious than residents who stayed on the regular care large-scale units. No significant differences were found on other aspects of quality of life. Conclusions This study demonstrates that residents who move from a large scale facility to a small scale environment can improve an aspect of quality of life by showing a reduction in anxiety. Trial registration Current Controlled Trials ISRCTN11151241. registration date: 21–06-2017. Retrospectively registered.
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Affiliation(s)
- Jeroen S Kok
- Lentis
- Dignis, Mental Health Care Institute, PO Box 128, 9470 AC, Zuidlaren, The Netherlands.
| | - Marjan M A Nielen
- ZINN, Mental Health Care Institute, PO Box 51, 9750 AB, Haren, The Netherlands
| | - Erik J A Scherder
- Department of Clinical Neuropsychology, VU University Amsterdam, van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
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Marquardt G, Bueter K, Motzek T. Impact of the design of the built environment on people with dementia: an evidence-based review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2018; 8:127-57. [PMID: 25816188 DOI: 10.1177/193758671400800111] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In this review the impact of the design of the built environment on people with dementia in long-term care settings is systematically analyzed and summarized. Architects and designers will be provided with credible evidence on which they can confidently base their design decisions. Researchers will be able to determine which environmental aspects have been well investigated and where there are gaps in the current state of the research. BACKGROUND A great number of studies have established a relationship between the design of the physical environment of long-term care settings and outcomes of people with dementia. However, the methods employed are heterogeneous and the results are often conflicting. Consequently, the process of integrating the best evidence available into architectural designs may be hindered. METHODS A systematic literature search was conducted reviewing studies that meet certain inclusion criteria. Using an evidence-based approach, the methodical quality of the studies was rated. RESULTS One hundred sixty-nine studies were found. They were thematically summarized into four main categories: basic design decisions, environmental attributes, ambience, and environmental information. The effectiveness of the interventions on the behavior, cognition, function, well being, social abilities, orientation, and care outcomes on people with dementia was illustrated by matrices. CONCLUSIONS Results of this review indicate that, with the exception of cognition, specific design interventions are beneficial to the outcomes of people with dementia. Overall, the field of environmental design for people with dementia is well researched in many aspects and only few gaps in knowledge were identified.
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Gilbert J, Ward L, Gwinner K. Quality nursing care in dementia specific care units: A scoping review. DEMENTIA 2017; 18:2140-2157. [DOI: 10.1177/1471301217743815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The concept of quality nursing care in a dementia specific unit is perceived as being subject to the interpretation of individuals, nurses and healthcare organisations. As the number of dementia diagnoses increases, understanding what constitutes quality nursing care within dementia specific care units is vital to inform policy makers and healthcare organisations globally. Efforts to identify quality nursing care and improve dementia care within dementia specific care units, may significantly reduce the financial and emotional burden of care-giving and improve the quality of life for individuals living with dementia. This scoping review aimed to examine current literature to gain an understanding of what constitutes quality nursing care in a dementia specific care unit. Design and methods Five electronic databases (CINAHL, MEDLINE, ProQuest, Social Sciences Citation Index and Ovid) were used to search for articles published in English between 2011 and 2016 focusing on a definition of quality nursing care within dementia specific care units. Findings: Twenty journal articles were identified. From these articles, two content themes were identified: Challenges in the provision of quality nursing care in dementia specific care units, and Standardised approach to quality nursing care in a dementia specific care unit. The articles contained the following research designs, controlled pre-test and post-test design ( n = 1), focus group interviews ( n = 1), cross sectional survey ( n = 6), semi structured interviews ( n = 3), narrative review ( n = 1), survey ( n = 2), literature review ( n = 3), systematic review ( n = 1), and prospective longitudinal cohort study ( n = 2). Conclusions The concept of quality nursing care in a dementia specific unit remains subject to the interpretation of individuals, nurses and healthcare organisations, with current literature unable to provide a clear definition. Further research into what constitutes quality nursing care in dementia specific care units is recommended.
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Affiliation(s)
- Julia Gilbert
- School of Nursing and Midwifery, Federation University, Australia
| | - Louise Ward
- Mental Health Nursing, La Trobe University, Australia
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Abstract
OBJECTIVES This study utilized qualitative methods to better understand long-term care (LTC) nursing staff's experience with hospice services and their perceptions of resident choice to utilize hospice services, as well as understand differences LTC nurses have experienced in regards to resident deaths. METHODS Interpretative Phenomenological Analysis (IPA) was utilized to extract themes and subthemes from 10 interviews that occurred with LTC nursing staff. Content analysis was also utilized to extract one noteworthy concept, which was a comparison of two resident deaths, with and without the utilization of hospice services. RESULTS Three main themes were extracted from the data: LTC nursing participant's positive view of hospice, their perception that residents view hospice very negatively, and why residents choose to utilize hospice services. Participants also identified aspects of a "bad" or "good" death, with clear relationships noted when using hospice services. CONCLUSIONS Findings identified a difference between the LTC nursing staff's positive view of hospice and their belief that their residents view hospice services very negatively. According to these nurses' experiences, to most residents, hospice meant something rather negative and feared. CLINICAL IMPLICATIONS An intervention providing information about hospice services for LTC resident population may increase the percentage of older adults who utilize hospice services.
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Hermabessière S, Lavallart B, Laffon de Mazières C, Vellas B, Rolland Y. [Reinforced accommodation units and the management of patients with dementia]. SOINS. GERONTOLOGIE 2016; 21:38-43. [PMID: 27449309 DOI: 10.1016/j.sger.2016.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Dementia is frequently associated with behavioural disorders that can be difficult to manage. In regards to these symptoms, psychoactive drugs are not very effective and have many potential side effects. In order to take care of patients with such severe disorders, specific units called "reinforced hosting units" ("UHR; Unités d'Hébergement Renforcées" in French) have been developed within long term care units. Specifically trained teams take care of these patients in specially designed settings. A French national inquiry has studied the development, the characteristics and the activity of these units in 2013 and 2012.
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Affiliation(s)
- Sophie Hermabessière
- Gérontopôle, CHU de Toulouse, Hôpital Garonne, 224 avenue de Casselardit, TSA 40031, 31059 Toulouse cedex 9, France.
| | - Benoît Lavallart
- Pilotage du plan Alzheimer, 11 place des cinq martyrs du lycée Buffon, pièce 5024, 75014 Paris, France
| | - Clarisse Laffon de Mazières
- Gérontopôle, CHU de Toulouse, Hôpital Garonne, 224 avenue de Casselardit, TSA 40031, 31059 Toulouse cedex 9, France
| | - Bruno Vellas
- Gérontopôle, CHU de Toulouse, Hôpital Purpan-Casselardit et Garonne, 170 et 224 avenue de Casselardit, TSA 40031, 31059 Toulouse Cedex 9, France
| | - Yves Rolland
- Gérontopôle, CHU de Toulouse, Hôpital Purpan-Casselardit et Garonne, 170 et 224 avenue de Casselardit, TSA 40031, 31059 Toulouse Cedex 9, France
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Abstract
Research literature in the dementia field lacks examples of ‘best-practices’ demonstrating concretely how it is possible to support the sense of coherence in people with dementia. The purpose of this study was to elucidate the nurses’ views concerning a caring approach that may support the sense of coherence in people with dementia. The data were collected through participant observation and focus group interviews during a four-month period in 2011. Sixteen registered nurses recruited from two Norwegian nursing homes participated in this study. The data were interpreted using a phenomenological-hermeneutical method. Three themes were identified: ‘being in the moment’, ‘doing one thing at a time’, and ‘creating joy and contentment’. An overall interpretation of these themes is described by the metaphor ‘slow nursing’, a caring approach that may lead to supporting the sense of coherence in people with dementia.
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Affiliation(s)
- Daniela Lillekroken
- Faculty of Health Sciences, Oslo and Akershus University College, Norway
- Faculty of Health and Sport Sciences, University of Agder, Norway
| | - Solveig Hauge
- Faculty of Health and Social Studies, Telemark University College, Norway
| | - Åshild Slettebø
- Faculty of Health and Sport Sciences, University of Agder, Norway
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Mjørud M, Kirkevold M, Røsvik J, Selbæk G, Engedal K. Variables associated to quality of life among nursing home patients with dementia. Aging Ment Health 2015; 18:1013-21. [PMID: 24911813 DOI: 10.1080/13607863.2014.903468] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To study which variables are associated with quality of life (QOL) in persons with dementia (PWD) living in nursing homes (NHs). METHODS A cross-sectional study included 661 PWD living in NH. To measure QOL the quality of life in late-stage dementia scale (QUALID) was applied. Other scales were: the clinical dementia rating scale (CDR), physical self-maintenance scale (PSMS), and neuropsychiatric inventory questionnaire (NPI-Q). RESULTS The patients' mean age was: 86.9 (SD 7.7), 472 (71.4%) were women. Of all, 22.5% had CDR 1, 33.6% had CDR 2, and 43.9% had CDR 3. The mean PSMS score was 18.2 (SD 5.0), 43.1% lived in special care units, 56.9% in regular units. In a linear regression analysis NPI-affective score (β = 0.360, p-value < 0.001), NPI-agitation score (β = 0.268, p-value < 0.001), PSMS total score (β = 0.181, p-value < 0.001), NPI-apathy (β = 0.144, p-value < 0.001), NPI psychosis (β = 0.085, p-value 0.009), CDR sum of boxes score (β = 0.081, p-value 0.026) were significantly associated with QUALID total score (explained variance 44.5%). CONCLUSION Neuropsychiatric symptoms, apathy, severity of dementia, and impairment in activities in daily living are associated with reduced QOL in NH patients with dementia.
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Affiliation(s)
- Marit Mjørud
- a Norwegian Centre for Ageing and Health , Vestfold Hospital Trust , Tønsberg , Norway
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Givens JL, Spinella S, Ankuda CK, D'Agata E, Shaffer ML, Habtemariam D, Mitchell SL. Healthcare Proxy Awareness of Suspected Infections in Nursing Home Residents with Advanced Dementia. J Am Geriatr Soc 2015; 63:1084-90. [PMID: 26031905 DOI: 10.1111/jgs.13435] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine healthcare proxy involvement in decision-making regarding infections in individuals with advanced dementia. DESIGN Prospective cohort study. SETTING Thirty-five Boston-area nursing homes (NHs). PARTICIPANTS NH residents with advanced dementia and their proxies (N = 362). MEASUREMENTS Charts were abstracted monthly (up to 12 months) for documentation of suspected infections and provider-proxy discussions for each episode. Proxies were interviewed within 8 weeks of the infection to determine their awareness and decision-making involvement. Factors associated with proxy awareness and discussion documentation were identified. RESULTS There were 496 suspected infections; proxies were reached for interview for 395 (80%). Proxy-provider discussions were documented for 207 (52%) episodes, yet proxies were aware of only 156 (39%). Proxies participated in decision-making for 89 (57%) episodes of which they were aware. Proxy awareness was associated with antimicrobial use (adjusted odds ratio (AOR) = 3.43, 95% confidence interval (CI) = 1.94-6.05), hospital transfer (AOR = 3.00, 95% CI = 1.19-7.53), infection within 30 days of death (AOR = 3.32, 95% CI = 1.54-7.18), and fewer days between infection and study interview (AOR = 2.71, 95% CI = 1.63-4.51). Discussion documentation was associated with the resident residing in a dementia special care unit (AOR = 1.71, 95% CI = 1.04-2.80), the resident not on hospice (AOR = 3.25, 95% CI = 1.31-8.02), more provider visits (AOR = 1.71, 95% CI = 1.07-2.75), proxy visits of more than 7 h/wk (AOR = 1.93, 95% CI = 1.02-3.67), and episode within 30 days of death (AOR = 3.99, 95% CI = 1.98-8.02). CONCLUSION Proxies are unaware of and do not participate in decision-making for most suspected infections that NH residents with advanced dementia experience. Proxy awareness of episodes and documentation of provider-proxy discussions are not congruent.
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Affiliation(s)
- Jane L Givens
- Hebrew SeniorLife Institute for Aging Research, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sara Spinella
- School of Medicine, University of Rochester, Rochester, New York
| | - Claire K Ankuda
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Erika D'Agata
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Michele L Shaffer
- Department of Pediatrics, Seattle Children's Research Institute, University of Washington and Children's Core for Biomedical Statistics, Seattle, Washington
| | | | - Susan L Mitchell
- Hebrew SeniorLife Institute for Aging Research, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Jethwa KD, Onalaja O. Advance care planning and palliative medicine in advanced dementia: a literature review. BJPsych Bull 2015; 39:74-8. [PMID: 26191437 PMCID: PMC4478901 DOI: 10.1192/pb.bp.114.046896] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 04/11/2014] [Accepted: 05/19/2014] [Indexed: 11/23/2022] Open
Abstract
Aims and method To assess the factors that affect the clinical use of advanced care planning and palliative care interventions in patients with dementia. A literature search of Medline, Embase and PsycINFO was performed to identify themes in advanced care planning and palliative care in dementia. Results In total, 64 articles were found, including 12 reviews, and three key areas emerged: barriers to advanced care planning, raising awareness and fostering communication between professionals and patients, and disease-specific interventions. Clinical implications Most of the studies analysed were carried out in the USA or Continental Europe. This narrative review aims to help guide future primary research, systematic reviews and service development in the UK.
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Affiliation(s)
- Ketan Dipak Jethwa
- University of Warwick and Coventry and Warwickshire Partnership NHS Trust
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Hofmann W, Rösler A, Vogel W, Nehen HG. [Special care units for acutely ill patients with cognitive impairment in Germany. Position paper]. Z Gerontol Geriatr 2014; 47:136-40. [PMID: 24619045 DOI: 10.1007/s00391-014-0612-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dementia is an increasing challenge for care providers in nursing homes and hospitals. Since the 1980s, special acute care units in nursing homes have developed rapidly. In Germany, the first unit in a hospital opened in 1990. In 2013, there were 22 units. MATERIALS AND METHODS In the following paper, the German Geriatric Society ("Deutsche Gesellschaft für Geriatrie e. V.") recommends basic standards for these wards. RESULTS The basic standards for these wards include the following: a maximum of 20 beds, an area physically separated from the geriatric hospital department, their own dayroom and therapy room, a structured daily routine suitable for patients with dementia, the selection of permanent staff on a voluntary basis, specialized training, extended geriatric assessment, and special consideration of the background and social situation of the patients.
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Affiliation(s)
- W Hofmann
- Deutsche Gesellschaft für Geriatrie (DGG) e. V., Kunibertskloster 11-13, 50668, Köln, Deutschland,
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Palm R, Köhler K, Schwab CGG, Bartholomeyczik S, Holle B. Longitudinal evaluation of dementia care in German nursing homes: the "DemenzMonitor" study protocol. BMC Geriatr 2013; 13:123. [PMID: 24237990 PMCID: PMC3840731 DOI: 10.1186/1471-2318-13-123] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 11/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Germany, the number of people with dementia living in nursing homes is rapidly increasing. Providing adequate care for their special needs is a challenge for institutions and their staff members. Because of the growing number of people with dementia, changes to the conceptual orientation of nursing homes have occurred. These changes include specialized living arrangements and psychosocial interventions recommended for people with dementia. Until now, the provision of dementia care and its association to the residents' behavior and quality of life is not well investigated in Germany. The purpose of this study is to describe the provision of dementia care and to identify resident- as well as facility-related factors associated with residents behavior and quality of life. METHODS/DESIGN The DemenzMonitor study is designed as a longitudinal study that is repeated annually. Data will be derived from a convenience sample consisting of nursing homes across Germany. For the data collection, three questionnaires have been developed that measure information on the level of the nursing home, the living units, and the residents. Data collection will be performed by staff members from the nursing homes. The data collection procedure will be supervised by a study coordinator who is trained by the research team. Data analysis will be performed on each data level using appropriate techniques for descriptions and comparisons as well as longitudinal regression analysis. DISCUSSION The DemenzMonitor is the first study in Germany that assesses how dementia care is provided in nursing homes with respect to living arrangements and recommended interventions. This study links the acquired data with residents' outcome measurements, making it possible to evaluate different aspects and concepts of care.
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Affiliation(s)
- Rebecca Palm
- German Centre for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 48453, Witten, Germany
- Witten/Herdecke University (UW/H), Faculty of Health, School of Nursing Science, Stockumer Str. 12, 48453, Witten, Germany
| | - Kerstin Köhler
- German Centre for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 48453, Witten, Germany
| | - Christian GG Schwab
- German Centre for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 48453, Witten, Germany
- Witten/Herdecke University (UW/H), Faculty of Health, School of Nursing Science, Stockumer Str. 12, 48453, Witten, Germany
| | - Sabine Bartholomeyczik
- Witten/Herdecke University (UW/H), Faculty of Health, School of Nursing Science, Stockumer Str. 12, 48453, Witten, Germany
| | - Bernhard Holle
- German Centre for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 48453, Witten, Germany
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Kok JS, Berg IJ, Scherder EJA. Special care units and traditional care in dementia: relationship with behavior, cognition, functional status and quality of life - a review. Dement Geriatr Cogn Dis Extra 2013; 3:360-75. [PMID: 24403908 PMCID: PMC3884203 DOI: 10.1159/000353441] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Special care facilities for patients with dementia gain increasing attention. However, an overview of studies examining the differences between care facilities with respect to their effects on behavior, cognition, functional status and quality of life is lacking. Results Our literature search resulted in 32 studies published until October 2012. Overall, patients with dementia who lived at special care units (SCUs) showed a significantly more challenging behavior, more agitation/aggression, more depression and anxiety, more cases of global cognitive impairment and a better psychosocial functioning. There was a tendency towards a better functional status in specialized care facilities, and a better quality of life was found in favor of the SCU group compared to the traditional nursing home (n-SCU) group. Longitudinal studies showed an increased number of neuropsychiatric cases, more patients displaying deteriorating behavior and resistance to care as well as less decline in activities of daily living (ADL) in the SCU group compared to the n-SCU group. Patients in small-scale, homelike SCUs showed more agitation and less ADL decline compared to SCU patients. Conclusion This review shows that the patient characteristics in SCU and n-SCU settings and, to a minor extent, in SCU and small-scale, homelike SCU settings are different. Over time, there are differences between n-SCU, SCU and small-scale, homelike SCU facilities for some variables.
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Affiliation(s)
- Jeroen S Kok
- Lentis/Dignis, Mental Health Care Institute, Zuidlaren, The Netherlands
| | - Ina J Berg
- Lentis/Dignis, Mental Health Care Institute, Zuidlaren, The Netherlands
| | - Erik J A Scherder
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
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