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

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.

Elder Abuse in Nursing Homes: Do Special Care Units Make a Difference? A Secondary Data Analysis of the Swiss Nursing Homes Human Resources Project

“…This might be surprising, since, according to Kok et al [31] , aggressive behavior -which contributes to the risk of being abused [16] -is more prevalent in residents of SCUs than in those of non-SCUs (a finding confirmed by our results) and might have resulted in higher rates of abuse. Care workers specialized in dementia care and suitable organizational/environmental structures might have positively influenced the interaction between direct care staff and residents, equaling the occurrence of emotional abuse and neglect between SCUs and nonSCUs.…”

“…Yet, the influence of SCUs' specific features on resident outcomes is unclear, the evidence of their positive relationship to resident or staff outcomes is weak [30] , and the prevalence of aggression in SCUs is higher than in non-SCUs [31] . There are, however, indications that SCUs contribute to reducing residents' aggressive behavior and care workers' job demands.…”

Quality of care for people with dementia and professional caregivers' perspectives regarding palliative care in Japanese community care settings

“…Furthermore, quality of life for patients treated in group homes was higher relative to that observed for patients treated via in‐home long‐term care support providers. Packaged care settings, such as those provided by group homes, could have exerted a positive effect on quality of life for patients with dementia, as suggested in previous studies (Verbeek et al ., ; Kok et al ., ). Packaged care settings where caregivers belonged to the same organization and comprised one care team may enable them to share the understanding of the person and goal of care, thus providing care that promotes a person's positive behaviour such as interaction with surroundings and self‐expression.…”

“…A list of drugs approved by the public healthcare insurance programme was provided in the questionnaire. The list of antipsychotics was established for the national survey, to develop national guidelines for use of psychotropic medication in treating challenging behaviour (Ministry of Health, Labour, and Welfare, ).…”

Empirical development of a typology on residential long-term care units in Germany - results of an exploratory multivariate data analysis

“…One goal was to answer the question of whether we can nd differences in the quality of care and in residents' outcomes between living units that are dementia-speci c and traditional care units. For reach this purpose, the initial aim was to investigate differences in the structural characteristics of different types of living units in German nursing homes based on the characteristics that are usually used to de ne dementia-speci c care units (size, segregation of residents with dementia, extra funding for additional staff resources) [2,11]. Next, we wanted to know if we would nd differences between living units that are small and large because it is proposed that small living units are bene cial for people with dementia (ibid).…”