No abstract

Background The quality of nursing home care for residents with advanced dementia has been described as suboptimal. One relatively understudied factor is the impact of special care units (SCUs) for dementia for residents at the end-stage of this disease. Objective To examine the association between residence in an SCU and the quality of end-of-life care for nursing home residents with advanced dementia. Research Design This study employed longitudinal data on 323 nursing home residents with advanced dementia living in 22 Boston-area facilities. Using multivariate methods, we analyzed the association between residence in an SCU and measures of quality of end-of-life care including: treatment of pain and dyspnea, prevalence of pressure ulcers, hospitalization, tube feeding, antipsychotic drug use, advance care planning, and health care proxy (HCP) satisfaction with care. Results A total of 43.7% residents were cared for in an SCU. After multivariate adjustment, residents in SCUs were more likely to receive treatment for dyspnea, had fewer hospitalizations, were less likely to be tube fed, and more likely to have a do-not-hospitalize order, compared to non-SCU residents. However, non-SCU residents were more likely to be treated for pain, had fewer pressure ulcers, and less frequent use of antipsychotic drugs than SCU residents. HCPs of SCU residents reported greater satisfaction with care than HCPs of non-SCU residents. Conclusions Residence in an SCU is associated with some, but not all, markers of better quality end-of-life care among nursing home residents with advanced dementia.

The resulting 37-item performance measurement tool was found to reliably measure public health functional capabilities in a tabletop exercise setting, with preliminary evidence of a factor structure consistent with the original conceptualization and of criterion-related validity.

Articles for From the Schools of Public Health highlight practice-and academic-based activities at the schools. To submit an article, faculty should send a short abstract (50-100 words) via e-mail to Allison Foster, ASPH Deputy Executive Director, at afoster@asph.org. In recent years, many questions have arisen about the nation's preparedness for a range of disasters, including terrorism, weather-related catastrophes, and biothreats. Particular concern has focused on the ability of the public health and health-care sectors to cope with a large-scale public health emergency such as pandemic influenza. On Linkages 1-3To bolster their response capabilities, local and state public health officials across the nation have revised and updated many of their emergency operation plans, purchased new equipment, and enhanced their training programs. Many of these changes, however, have gone untested. Often it remains unknown whether public health personnel are appropriately trained in the new plans and procedures; how well new equipment such as communications or surveillance systems will function; or the degree to which these new plans are integrated with the capabilities of other emergency responders, such as law enforcement, fire services, emergency medical services (EMS), emergency management, hospitals, health centers, and others.Exercises that simulate emergencies have frequently been recommended as a means to improve preparedness. [4][5][6][7][8][9] Broadly speaking, they can significantly help improve preparedness on two levels. At the individual level, exercises present an opportunity to educate personnel on disaster plans and procedures through hands-on practice, while offering constructive critiques of their actions. 10,11