Hospitalization Rates in Nursing Home Residents with Dementia

Abstract

Although Special Care Units (SCUs) have recently gained attention as appropriate places for caring for institutionalized patients with dementia, few studies have evaluated their effectiveness. This pilot study focused primarily on one aspect of patient care, the possible prevention of acute hospitalization. Because transfer from nursing home to the acute hospital can be a traumatic experience for patients with dementia, important services that SCUs might provide include those preventive strategies aimed at reducing the need for transfer to the acute hospital. Medical record abstraction revealed that over one year, the rate of acute hospitalization was 21% among 47 patients with dementia in SCUs, compared with 14% among 36 patients with dementia and 14% among 22 patients with no listed diagnosis of dementia residing in non-SCU settings within the same facility. Thus, no statistically significant difference in hospitalization rates was found, although the trend was for increased hospitalization for SCU patients. There was a trend toward deterioration in functional status among SCU patients following first hospitalization (P less than .10). Since the majority of these patients were hospitalized for hip fractures, this finding was not unexpected. There was a trend toward cognitive decline after hospitalization among patients with dementia who were not residing in an SCU (P less than .10). In order to investigate whether acute hospitalizations among SCU patients were preventable, an expert panel was convened to review each episode of illness leading to acute hospitalization. Of the 15 hospitalizations, none were judged "preventable," four were believed to be "possibly preventable," and 11 were considered to have been "not preventable."(ABSTRACT TRUNCATED AT 250 WORDS)

Special Care Units and Traditional Care in Dementia: Relationship with Behavior, Cognition, Functional Status and Quality of Life - A Review

“…A greater global cognitive impairment in the SCU group was found in 10 studies with large [33,38,39,42], moderate [20,28,36] and small effect sizes [21,34] or significant p values [43]. In contrast, 1 study showed an increased cognitive impairment with a large effect size in a limited number of participants [35], and 1 study showed a moderate effect size in a younger n-SCU patient group [9].…”

“…self-care, for the n-SCU group with large [38], small [33] and very small [20,31] effect sizes or p values [43]. …”

Is Dementia Special Care Really Special? A New Look at an Old Question

“…This is troublesome, because there are well‐reported differences between NHs with and without SCUs on a variety of measures. Of studies with control groups from the same NH, some did not appear to acknowledge or control for the differences between SCU and non‐SCU residents 22,70 . The design of this study attempted to overcome some of these limitations.…”

“…[14][15][16][17][18] Studies focused on how care is provided have shown some differences, but these have often been inconsistent. [19][20][21][22][23] Further complicating the issue, problems in study design, especially control group selection, make findings difficult to interpret and limit knowledge on ''true'' SCU effects.…”

A longitudinal evaluation of residents’ health outcomes in nursing homes and residential care homes in Taiwan

“…Our results also showed progressive worsening of subjective health and increased mortality in RH residents versus those in NHs. For those who are medically unstable or with poor physical functioning, NHs may help them avoid hospitalization and both reduce and prevent the functional deterioration that frequently follows hospitalization [26]. NH nursing homes, RH residential care homes.…”