Dimensions of Care for Dementia Sufferers in Long-Term Care Institutions: Are They Related to Outcomes?

Abstract

Objectives. This study empirically examined whether dimensions of care cluster in special care units (SCUs) compared with non-SCUs. The relationship between SCU status plus separate measures of the dimensions of care and outcomes for dementia sufferers was then investigated.Methods. Data were drawn from the Intermediate Care Facility Project. The sample ( N ϭ 510) included residents with dementia, aged 65 and older, in intermediate care facilities throughout the province of British Columbia, Canada. Longitudinal data included 6 outcomes: cognitive function, behavioral problems of agitation and social skills, physical functioning, and quality of life measured through affect and expressive language skills. Separate multiple linear regression equations were estimated, relating each of these outcomes to 5 dimensions of care: preadmission and admission procedures, staff training and education, nonuse of physical and chemical restraints, flexible care routines and residentrelevant activities, and the environment. Results.The results showed there is virtually no clustering of dimensions along SCU/non-SCU lines. Neither SCU status nor the individual dimensions were highly predictive of outcomes. Residents' affect at t 1 emerged as a characteristic that was significantly correlated with other outcomes.Discussion. This Canadian research can be added to the few but growing number of rigorous studies that suggest SCUs are not homogeneous and do not necessarily provide better care than non-SCUs. Moreover, it raises questions about the benefits of "best practice" dimensions of care, regardless of SCU status.S the demographic shift continues, the proportion of elderly persons and of old elderly persons in society is increasing. The risk of dementia rises rapidly with age among the oldest age groups, and thus the number of individuals with more severe levels of dementia has increased. Long-term care facilities, as a result, now tend to house higher proportions of residents who suffer from advanced dementia than was true in the past. To meet this demand, providers of care have of necessity been experimenting with management in this area. This experimentation has resulted in the identification, rethinking, and implementation of several dimensions of care , such as assessment and care planning, staff training, flexible care routines, individualized care plans, and the environmental setting.It is commonly thought that such dimensions of care, adequately implemented and in the right combination, will result in optimal outcomes for residents suffering from dementia (Holmes et al., 1994). Although these dimensions of care are in theory expected to result in superior outcomesand thus have become the philosophy behind the creation of special care units (SCUs)-their effects on outcomes are not fully known. In this study we empirically examined whether such "best practices" dimensions of care or a subset of them are, in fact, more likely to be implemented within SCUs. We also examined whether specific dimensions or combinations of dimensi...

Unités spécifiques Alzheimer en EHPAD et prise en charge des troubles sévères du comportement: réflexion sur les critères de définition et missions

“…D'autres auteurs ont aussi discuté ces propositions la même année [33,34]. L'implication de la famille s'est ensuite ajoutée à la définition et se trouve souvent évoquée [35][36][37]. Mais les structures qui se définissent comme SCU ne proposent pas toutes les mêmes critères.…”

Dementia and Assisted Living

“…Although the literature that came out of the National Institute on Aging Collaborative Studies of Dementia Special Care Units and the work of the various members of The Gerontological Society of America's Workgroup on Research in Special Care Units focused on nursing homes , much of that work is relevant to dementia services in assisted living. Overall, although providers and experts generally believe that SCUs offer benefits to residents, most of the research on SCUs in nursing homes has found that living in an SCU does not, in itself, appear to lead to better outcomes (Chappell & Reid, 2000;Phillips et al, 1997). For example, a study of the advantages of mainstreaming versus living in a special unit in assisted living (Kuhn, Kasayka, & Lechner, 2002) suggested that mainstreamed residents might be more engaged in social activities.…”

“…In the long-term-care field, most research has focused on the relationship of structure and process, as mediated by resident characteristics, on resident outcomes. Chappell and Reid (2000) identified five dimensions of care in their literature review that are generally considered to be relevant to outcomes in dementia care. These are: assessment and diagnosis; staff specialization and ongoing education; nonuse of restraints (both physical and chemical); flexible care routines, including client-relevant activities; and specialized environmental design and adaptation.…”

Non-Drug Therapies for Dementia: An Overview of the Current Situation with Regard to Proof of Effectiveness

“…Analyses of the connection between the dimensions of care and patient-related outcome variables indicate that for a large sample of dementia patients (510 residents in long-term care institutions in Canada) there is a significant, though not particularly marked, correlation between staff training and the patients' agitation [62]. The more training the staff received, the smaller the rise in agitation in the course of a year.…”

“…No significant correlation was established between staff training and the patients' physical functioning, expressive language skills, social skills, affect or cognitive functioning. The scores given by Chappell and Reid [62] to the value of staff training relate to a large variety of different types of training conducted in the care units which were studied, but the question remains as to which kinds of staff training most effectively influence the behaviour of the dementia patients, and this question can be answered only by using results from intervention studies.…”