Systematic Review: Effective Characteristics of Nursing Homes and Other Residential Long‐Term Care Settings for People with Dementia

Abstract

OBJECTIVES:In response to the need for an evidencebased review of factors within long-term care settings that affect the quality of care, this review compared characteristics of nursing homes and other residential long-term care settings for people with dementia and their informal family caregivers with respect to health and psychosocial outcomes. DESIGN: Databases were searched for literature published between 1990 and March 2012 that met review criteria, including that at least 80% of the subject population had dementia. RESULTS: Fourteen articles meeting review criteria that were of at least fair quality were found: four prospective cohort studies, nine randomized controlled trials (RCTs), and one nonrandomized controlled trial. Overall, low or insufficient strength of evidence was found regarding the effect of most organizational characteristics, structures, and processes of care on health and psychosocial outcomes for people with dementia and no evidence for informal caregivers. Findings of moderate strength of evidence indicate that pleasant sensory stimulation reduces agitation for people with dementia. Also, although the strength of evidence is low, protocols for individualized care and to improve function result in better outcomes for these individuals. Finally, outcomes do not differ between nursing homes and residential care or assisted living settings for people with dementia except when medical care is indicated. CONCLUSION:Given the paucity of high-quality studies in this area, additional research is needed to develop a sufficient evidence base to support consumer selection, practice, and policy regarding the best settings and characteristics of settings for residential long-term care of people with dementia. J Am Geriatr Soc 61:1399-1409, 2013.Key words: dementia; structures; processes; nursing homes; residential care/assisted living; systematic review M ore than 5 million Americans have dementia.1 This number will rise to between 8 and 13 million by 2050.2 Dementia causes significant morbidity and mortality and creates a substantial burden on the people affected, caregivers, health systems, and society.1 It gradually erodes an individual's ability to make decisions, manage personal affairs, and eventually to perform simple tasks such as dressing, toileting, and eating. Weight loss, limited mobility, and frequent infections characterize the late stages of dementia. Unless another illness is fatal sooner, dementia will lead to death. The course of dementia from diagnosis to death is variable but typically is from 8 to 12 years. Costs of dementia care, including medical care and informal caregiver time, are estimated at more than $148 billion in the United States annually. 3Although family members provide the majority of care for people with dementia, increasing needs over time often lead to placement in a long-term care setting; dementia is the most common reason for entry into nursing homes (NHs) and residential care or assisted living (RC/AL), where together more than 1 million people with dementi...

Dementia Prevalence And Care In Assisted Living

“…22 There is little evidence that having special care results in better outcomes. 6,7,23 However, it is worth noting that the national data reported here indicate that there are more licensed staff working on these units than in other assisted living residences.…”

“…Residents with worse cognition and ADL functions generally experience poorer quality of life, but that quality is influenced more by considerations other than individual characteristics. 33 For example, other studies 7 have found that pleasant sensory stimulation and using protocols for individualized care to improve function result in better outcomes. Thus, assisted living residences that embrace such practices may be preferred to residences that do not.…”

“…6 Similarly, a systematic review of the structures and processes of care in nursing homes and other residential long-term settings found that residents who were in special care units in assisted living experienced more functional decline than those who were not. 7 To date, most of what is known about assisted living, and more specifically about residents with dementia in assisted living, has been obtained from studies involving a limited number of residences or using state 8 or multistate 9 samples instead of national samples. This study used national data, which recently became available, to describe the proportions and characteristics of assisted living residents with mild, moderate, and severe cognitive impairment; the characteristics of the residences in which they live; and the residences' dementia-related staffing and training, policies, and practices and costs for care.…”

Pårørende en betinget ressurs? En kvalitativ studie av pårørende til langtidsbeboere i sykehjem sine erfaringer av egen rolle

“…I stortingsmeldingen «Morgendagens omsorg» (Meld. St. 29 (2012−2013, 2013) blir det imidlertid pekt på at samhandlingen med pårørende ofte er mangelfull og tilfeldig, og det etterlyses mer forskning som grunnlag for nye måter å samarbeide på. Spørsmålet er hvilket innhold og kvaliteter som vil vaere av betydning i støtten av pårørende.…”

“…St. 29 (2012−2013), 2013. Mange land satser på mer hjemmetjenester som en løsning, og prioriterer de eldste og personer med de mest uttalte behov for 24 timers pleie og omsorg til sykehjem (OECD, 2005).…”