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Dementia special care units: a comparison with standard units regarding residents’ profile and care features

Published online by Cambridge University Press:  02 September 2013

María Crespo*
Affiliation:
Department of Clinical Psychology, Complutense University, Madrid, Spain.
Carlos Hornillos
Affiliation:
Department of Clinical Psychology, Complutense University, Madrid, Spain.
M. Mar Gómez
Affiliation:
Department of Clinical Psychology, Complutense University, Madrid, Spain.
*
Correspondence should be addressed to: Dr María Crespo, Facultad de Psicología, Universidad Complutense de Madrid, Campus de Somosaguas s/n, 28223 Madrid, Spain. Phone: +34-91-394-31-22; Fax: +34-91-394-31-89. Email: [email protected].

Abstract

Background:

Unlike other countries, no data about residents and care features in Special Care Units (SCUs) in Spanish nursing homes have been reported to date. The present paper is the first to analyze the characteristics of residents with dementia and the features of provided care in SCUs in comparison to residents with dementia in standard beds, thus not receiving specialized care in nursing homes in Spain.

Methods:

Data on residents with dementia were collected in 11 nursing homes. Residents with diagnosis of dementia and Mini-Mental State Examination scores of less than 27 were randomly selected in each center. Altogether 197 residents were assessed: 102 (52%) placed in SCUs, and 95 (48%) in standard beds. Analyses of the characteristics of residents in SCUs versus standard beds regarding socio-demographic and clinical variables, features of the care provided, and residents’ quality of life (QoL) were performed using univariate and multivariate tests (binary logistic regression analysis).

Results:

Residents in SCUs did not differ from those in standard beds in socio-demographic variables. Placement of residents in SCUs seemed to be related with the presence of severe cognitive and functional impairment and aggressive behaviors. Being in an SCU conveyed a higher probability of having individual bedroom and bathroom; nevertheless, there were no differences in the care provided in SCUs, considering use of nappies, and feeding and restraint systems. Patients in SCUs showed lower QoL reported by the staff.

Conclusions:

Although residents in SCUs present higher levels of impairment, there are no real differences in the care provided besides a higher probability of having individual rooms. Regulations on required features for SCUs in Spain are necessary to guarantee that care provided to residents is truly special.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2013 

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References

Alexopoulos, G. A., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988). Cornell Scale for Depression in dementia. Biological Psychiatry, 23, 271284. doi:10.1016/0006-3223(88)90038-8.CrossRefGoogle ScholarPubMed
Berg, L.et al. (1991). Special care units for persons with dementia. Journal of American Geriatrics Society, 39, 12291236.CrossRefGoogle ScholarPubMed
Buchanan, R. J., Choi, M., Wang, S., Ju, H. and Graber, D. (2005). Nursing home residents with Alzheimer's disease in special care units compared to other residents with Alzheimer's disease. Dementia, 4, 249267. doi:10.1177/14713.CrossRefGoogle Scholar
Cohen-Mansfield, J. (1986). Agitated behaviors in the elderly. II Preliminary results in the cognitively deteriorated. Journal of the American Geriatrics Society, 34, 722727.CrossRefGoogle ScholarPubMed
Crespo, M., Bernaldo de Quirós, M., Gómez, M. and Hornillos, C. (2012). Quality of life of nursing home residents with dementia: comparison of perspectives of residents, family and staff. Gerontologist, 52, 5665. doi:10.1093/geront/gnr080.CrossRefGoogle ScholarPubMed
Crespo, M., Hornillos, C. and Bernaldo de Quirós, M. (2013a). Factors associated with quality of life in dementia patients in long-term care. International Pyschogeriatrics, 25, 577585. doi:10.1017/S1041610212002219.CrossRefGoogle ScholarPubMed
Crespo, M., Hornillos, C. and Gómez, M. M. (2013b). Assessing quality of life of nursing home residents with dementia: feasibility and limitations in patients with severe cognitive impairment. International Pyschogeriatrics. doi:10.1017/S1041610213000823.CrossRefGoogle ScholarPubMed
Edelman, P., Fulton, B. R., Kuhn, D. and Chang, C. H. (2005). A comparison of three methods of measuring dementia-specific quality of life: perspectives of residents, staff, and observers. Gerontologist, 4, 2736. doi:10.1093/geront/45.suppl_1.27.CrossRefGoogle Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.CrossRefGoogle Scholar
Gerdner, L. A. and Beck, C. K. (2001). State-wide survey to compare services provided for residents with dementia in special care units and non-special care units. American Journal of Alzheimer's Disease and Other Dementias, 16, 289295. doi:10.1177/153331750101600506.CrossRefGoogle Scholar
Gerdner, L. A. and Beck, C. K. (2006). Impact of Arkansas state regulations for certification of Alzheimer's special care units. Alzheimer's Care Quarterly, 7, 251257.Google Scholar
González-Salvador, T.et al. (2000). Quality of life in dementia patients in long-term care. International Journal of Geriatric Psychiatry, 15, 181189. doi:10.1002/(SICI)1009-1166(200002)15:2<181::AID-GPS96>3.0.CO;2-I.3.0.CO;2-I>CrossRefGoogle ScholarPubMed
Gruneir, A., Lapane, K. L., Miller, S. C. and Mor, V. (2008). Is dementia special care really special? A new look at an old question. Journal of the American Geriatrics Society, 56, 199205. doi:10.1111/j.1532-5415.2007.01559.x.CrossRefGoogle Scholar
Hoe, J., Hancock, G., Livingston, G. and Orrell, M. (2006). Quality of life in people with dementia in residential care homes. British Journal of Psychiatry, 188, 460464. doi:10.1192/bjp.bp.104.007658.1.CrossRefGoogle ScholarPubMed
Holmes, D.et al. (1990). Impacts associated with special care units in long-term facilities. Gerontologist, 30, 178183. doi:10.1093/geront/30.2.178.CrossRefGoogle Scholar
IMSERSO. (2010). Las Personas Mayores en España (The Older People in Spain.), Report 2010. Madrid, Spain: Institute of Older Persons and Social Services (IMSERSO).Google Scholar
Leon, J. (1998). Charateristics of dementia admissions to standard nursing homes and to special care units. American Journal of Alzheimer's Disease and Other Dementias, 13, 1518. doi:10.1177/153331759801300104.CrossRefGoogle Scholar
Leon, J., Cheng, C. K. and Alvarez, R. (1997). Trends in special care: changes in SCU from 1991 to 1995 (1995/96 TSC). Journal of Mental Health and Aging, 3, 149168.Google Scholar
Leon, J. and Ory, M. G. (1999). Effectiveness of special care unit (SCU) placements in reducing physically aggressive behaviors in recently admitted dementia nursing home residents. American Journal of Alzheimer's Disease and Other Dementias, 14, 270277. doi:10.1177/153331759901400503.CrossRefGoogle Scholar
Logsdon, R. G., Gibbons, L. E., McCurry, S. M. and Teri, L. (2002). Assessing quality of life in older adults with cognitive impairment. Psychosomatic Medicine, 64, 510519.CrossRefGoogle ScholarPubMed
Luo, H., Fang, X., Liao, Y., Elliott, A. and Zhang, X. (2010). Associations of special care units and outcomes of residents with dementia: 2004 National Nursing Home Survey. Gerontologist, 50, 509518. doi:10.1093/geront/gnq035.CrossRefGoogle ScholarPubMed
Mahoney, F. I. and Barthel, D. W. (1965). Functional evaluation: the Barthel Index. Maryland Medical Journal, 14, 6165.Google ScholarPubMed
Maslow, K. and Ory, M. (2001). Review of a decade of dementia special care unit research: lessons learned and future directions. Alzheimer's Care Quarterly, 2, 1016.Google Scholar
Nobili, A.et al. (2008). Alzheimer special care units compared with traditional nursing home for dementia care. Are there differences at admission and in clinical outcomes? Alzheimer Disease & Associated Disorders, 22, 352361. doi:10.1097/WAD.0b013e31818207d0.1.CrossRefGoogle ScholarPubMed
Park, N. S., Zimmerman, S., Sloane, P. D., Gruber-Baldini, A. L. and Eckert, J. K. (2006). An empirical typology of residential care/assisted living based on a four-state study. Gerontologist, 46, 238248. doi:10.1093/geront/46.2.238.CrossRefGoogle ScholarPubMed
Phillips, C. D.et al. (1997). Effects of residence in Alzheimer's disease special care units on functional outcomes. Journal of American Medical Association, 278, 13401344. doi:10.1001/jama.1997.03550160060039.CrossRefGoogle ScholarPubMed
Phillips, C. D., Spry, K. M., Sloane, P. D. and Hawes, C. (2000). Use of physical restraints and psychotropic medications in Alzheimer's special care units in nursing homes. American Journal of Public Health, 90, 9296.Google ScholarPubMed
Reisberg, B., Ferris, S. H., de Leon, M. J. and Crook, T. (1982). The global deterioration scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 11361139. 1.Google ScholarPubMed
Riter, R. N. and Fries, B. E. (1992). Predictors of the placement of cognitively impaired residents on special care units. Gerontologist, 32, 184190. doi:10.1093/geront/32.2.184.CrossRefGoogle ScholarPubMed
Sloane, P. D., Zimmerman, S. and Walsh, J. F. (2001). The physical environment. In S. Zimmerman, P. D. Sloane and J. K. Eckert (eds.), Assisted Living (pp. 173197). Baltimore, MD: Johns Hopkins University Press.Google Scholar
US Congress, Office of Technology Assessment. (1992). Special Care Units for People With Alzheimer's and Other Dementias: Consumer Education, Research, Regulatory, and Reimbursement Issues, OTA-H-543. Washington, DC: U.S. Government Printing Office.Google Scholar
Weiner, A. S. and Reingold, J. (1989). Special care units for dementia: current practice models. Journal of Long-Term Care Administration, 17, 1419.Google ScholarPubMed