Is dementia special care really special? A new look at an old question

Journal of the American Geriatrics Society

Volumn 56, Issue 2, 2008, Pages 199-205

  Gruneir, Andrea ^a,b   Lapane, Kate L ^b   Miller, Susan C ^a,b   Mor, Vincent ^a,b  

^a Kunin Lunenfeld Applied Research Unit and Department of Food and Nutrition Services and Baycrest Centre for Geriatric Care   (Canada)

^b BROWN UNIVERSITY   (United States)

Author keywords

Dementia; Minimum Data Set; Nursing homes; Special care units

Indexed keywords

NEUROLEPTIC AGENT; PSYCHOTROPIC AGENT;

AGED; ALZHEIMER DISEASE; ARTICLE; COGNITIVE DEFECT; CONTROLLED STUDY; DEMENTIA; FEMALE; GERIATRIC CARE; HUMAN; INCONTINENCE; INSTITUTIONALIZATION; MAJOR CLINICAL STUDY; MALE; NURSING HOME;

CROSS-SECTIONAL STUDIES; DEMENTIA; FEMALE; HEALTH SERVICES FOR THE AGED; HEALTH STATUS INDICATORS; HUMANS; MALE; NURSING HOMES; OUTCOME AND PROCESS ASSESSMENT (HEALTH CARE); REGRESSION ANALYSIS; UNITED STATES;

EID: 38549117766     PISSN: 00028614     EISSN: 15325415     Source Type: Journal    
DOI: 10.1111/j.1532-5415.2007.01559.x     Document Type: Article

References (72)

1. Magaziner J, German P, Zimmerman SI et al. The prevalence of dementia in a statewide sample of new nursing home admissions aged 65 and older: Diagnosis by expert panel. Gerontologist 2000 40 : 663 672.
2. Smith GE, Kokmen E, O'Brien PC. Risk factors for nursing home placement in a population-based dementia cohort. J Am Geriatr Soc 2000 48 : 519 525.
3. Maas ML, Swanson E, Specht J et al. Alzheimer's special care units. Nurs Clin N Am 1994 29 : 173 194.
4. Weiner AS, Reingold J. Special care units for dementia: Current practice models. J Long Term Care Admin 1989 17 : 14 19.
5. Volicer L. Goals of dementia special care units. In : Holmes D, Teresi JA, Ory M, eds. Special Care Units. New York : Springer Publishing Company, 2000, pp 93 103.
6. AHRQ Research Findings No. 6: Special Care Units in Nursing Homes - Selected Characteristics, 1996. Agency for Healthcare Research and Quality 2000 [on-line] Available at 1996 Accessed August 20, 2005.
7. Gruneir A, Lapane KL, Miller SC et al. Dementia Special Care Units in U.S. Nursing Homes: A Current Description of Distribution and Major Features. Presented at the Gerontological Society of America Annual Scientific Meeting, November 16-20, 2006, Dallas, TX, 2006
8. Grant L, Potthoff SJ, Ryden MB et al. Staff ratios, training, and assignment in Alzheimer's special care units. J Gerontol Nurs 1998 24 : 9 16.
9. Leon J. The 1990/1991 National survey of special care units in nursing homes. Alzheimer Dis Assoc Dis 1994 8 (Suppl 1) : S72 S86.
10. Grant L, Kane RA, Potthoff SJ et al. Staff training and turnover in Alzheimer special care units: Comparisons with non-special care units. Geriatr Nurs 1996 17 : 278 282.
11. Holmes D, Teresi J, Monaco C. Special care units in nursing homes: Prevalence in five states. Gerontologist 1992 32 : 191 196.
12. Rabins PV. Establishing Alzheimer's disease units in nursing homes: Pros and cons. Hosp Comm Psychol 1986 37 : 120 121.
13. U.S. Congress OoTA. Special Care Units for People with Alzheimer's and other dementias: Consumer Education, Research, Regulatory, and Reimbursement Issues. Washington, D.C.: U.S. Government Printing Office; 1992. Report No.: OTA-#-543.
14. Chappell NL, Reid RC. Dimensions of care for dementia sufferers in long-term care institutions: Are they related to outcomes? J Gerontol B Soc Sci Med Sci 2000 55B : S234 S244.
15. Chafetz PK. Behavioral and cognitive outcomes of SCU care. Clin Gerontol 1991 11 : 19 38.
16. Holmes D, Teresi J, Weiner A et al. Impacts associated with special care units in long-term care facilities. Gerontologist 1990 30 : 178 183.
17. McCann JJ, Bienias JL, Evans DA. Change in performance tests of activities of daily living among residents of dementia special care and traditional nursing home units. In : Holmes D, Teresi J, Ory M, eds. Special Care Units. New York : Springer Publishing Company, 2000, pp 141 150.
18. Phillips C, Sloane PD, Hawes C et al. Effects of residence in Alzheimer disease special care units on functional outcomes. JAMA 1997 278 : 1340 1344.
19. Phillips C, Spry KM, Sloane PD et al. Use of physical restraints and psychotropic medications in Alzheimer special care units in nursing homes. Am J Public Health 2000 90 : 92 96.
20. Volicer L, Collard A, Hurley A et al. Impact of special care unit for patients with advanced Alzheimer's disease on patients' discomfort and costs. J Am Geriatr Soc 1994 42 : 597 603.
21. Sloane PD, Mathew LJ, Scarborough M et al. Physical and pharmacologic restraint of nursing home patients with dementia. Impact of specialized units. JAMA 1991 265 : 1278 1282.
22. Coleman EA, Barbaccia JC, Croughan-Minihane MS. Hospitalization rates in nursing home residents with dementia. A pilot study of the impact of a special care unit. J Am Geriatr Soc 1990 38 : 108 112.
23. Sand BJ, Yeaworth RC, McCabe BW. Alzheimer's disease special care units in long-term care facilities. J Gerontol Nurs 1992 18 : 28 34.
24. Hawes C, Morris JN, Phillips CD et al. Development of the nursing home Resident Assessment Instrument in the USA. Age Ageing 1997 26 (Suppl 2) : 19 25.
25. Phillips CD, Morris JN. The potential for using administrative and clinical data to analyze outcomes for the cognitively impaired: An assessment of the Minimum Data Set for nursing homes. Alzheimer Dis Assoc Dis 1997 11 (Suppl. 6) : S162 S167.
26. Mor V. A comprehensive clinical assessment tool to inform policy and practice. Applications of the minimum data set. Med Care 2004 42 (Suppl. 4) : III-50 III-59.
27. AHCA. CMS OSCAR Data. AHCA 2004
28. Gambassi G, Lapane KL, Sgadari A et al. Prevalence, clinical correlates, and treatment of hypertension in elderly nursing home residents. SAGE Study Group. Arch Intern Med 1998 158 : 2377 2385.
29. Won A, Lapane KL, Gambassi G et al. Correlates and management of nonmalignant pain in the nursing home. SAGE Study Group. Systematic assessment of geriatric drug use via epidemiology. J Am Geriatr Soc 1999 47 : 936 942.
30. Intrator O, Zinn J, Mor V. Nursing home characteristics and potentially preventable hospitalizations of long-stay residents. J Am Geriatr Soc 2004 52 : 1730 1736.
31. Morris JN, Fries BE, Mehr DR et al. MDS cognitive performance scale. J Gerontol 1994 49 : M174 M182.
32. Maslow K. Current knowledge about special care units: Findings of a study by the U.S. office of technology assessment. Alzheimer Dis Assoc Dis 1994 8 : S14 S40.
33. Leon J, Cheng C, Alvarez RJ. Trends in special care: Changes in SCU from 1991 to 1995 ('95/96 TSC). J Ment Health Aging 1997 3 : 149 168.
34. Holmes D, Teresi J. Personnel costs in special dementia care units compared with costs on traditional care units. In : Holmes D, Teresi J, Ory M, eds. Special Care Units. New York : Springer Publishing Company, 2000, pp 199 215.
35. Lindeman D, Arnsberger P, Owens D. Staffing and specialized dementia care units: Impact on resident outcomes. In : Holmes D, Teresi J, Ory M, eds. Special Care Units. New York : Springer Publishing Company, 2000, pp 217 227.
36. Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q 1966 44 : S166 S206.
37. Mitchell SL, Kiely DK, Lipsitz LA. The risk factors and impact on survival of feeding tube placement in nursing home residents with severe cognitive impairment. Arch Intern Med 1997 157 : 327 332.
38. Mitchell SL, Teno JM, Roy J et al. Clinical and organizational factors associated with feeding tube use among nursing home residents with advanced cognitive impairment. JAMA 2003 290 : 73 80.
39. Finucane TE, Christmas C, Travis K. Tube feeding in patients with advanced dementia: A review of the evidence. JAMA 1999 282 : 1365 1370.
40. Odom SR, Barone JE, Docimo S et al. Emergency department visits by demented patients with malfunctioning feeding tubes. Surg Endosc 2003 17 : 651 653.
41. Castle NG, Mor V. Physical restraints in nursing homes: A review of the literature since the Nursing Home Reform Act of 1987. Med Care Res Rev 1998 55 : 139 170.
42. Castle NG, Fogel B, Mor V. Risk factors for physical restraint use in nursing homes: Pre- and post-implementation of the Nursing Home Reform Act. Gerontologist 1997 37 : 737 747.
43. Burton LC, German PS, Rovner BW et al. Physical restraint use and cognitive decline among nursing home residents. J Am Geriatr Soc 1992 40 : 811 816.
44. Capezuti E, Evans L, Strumpf N et al. Physical restraint use and falls in nursing home residents. J Am Geriatr Soc 1996 44 : 627 633.
45. Miles SH, Irvine P. Deaths caused by physical restraints. Gerontologist 1992 32 : 762 766.
46. Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: A systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 1999 47 : 30 39.
47. Monette J, Gurwitz JH, Avorn J. Epidemiology of adverse drug events in the nursing home setting. Drugs Aging 1995 7 : 203 211.
48. Hughes CM, Lapane KL, Mor V. Influence of facility characteristics on use of antipsychotic medications in nursing homes. Med Care 2000 38 : 1164 1173.
49. Smith DA. Urinary incontinence: Epidemiology, demographics, and costs. Director 2003 11 : 115 118.
50. Reznicek SB. Management of incontinence in the elderly. J Gend Specif Med 2002 5 : 43 48.
51. Robinson JP. Managing urinary incontinence in the nursing home: Residents' perspectives. J Adv Nurs 2000 31 : 68 77.
52. Tannenbaum C, DuBeau CE. Urinary incontinence in the nursing home: Practical approach to evaluation and management. Clin Geriatr Med 2004 20 : 437 452.
53. Hartmaier SL, Sloane PD, Guess HA et al. Validation of the minimum data set cognitive performance scale: Agreement with the Mini-Mental State Examination. J Gerontol A Biol Sci Med Sci 1995 50 : AM128 M133.
54. Morris JN, Fries BE, Morris SA. Scaling ADLs within the MDS. J Gerontol A Biol Sci Med Sci 1999 54 : M546 AM553.
55. Greenland S. Interpretation and estimation of summary ratios under heterogeneity. Stat Med 1982 1 : 217 227.
56. Greenland S. Estimating variances of standardized estimators in case-control studies and sparse data. J Chronic Dis 1986 39 : 473 477.
57. Holmes D, Teresi J, Kong J. Service inputs and costs of care related to outcomes among cognitively impaired nursing home residents. J Ment Health Policy Econ 2000 3 : 121 127.
58. Phillips VL, Potter SJ, Simon SL. Special care units for Alzheimer's patients: Their role in the nursing home market. J Health Human Serv Admin 1998 20 : 300 310.
59. Mitchell SL, Buchanan JL, Littlehale S et al. Tube-feeding versus hand-feeding nursing home residents with advanced dementia: A cost comparison. J Am Med Dir Assoc 2003 4 : 27 33.
60. Engel SE, Kiely DK, Mitchell SL. Satisfaction with end-of-life care for nursing home residents with advanced dementia. J Am Geriatr Soc 2006 54 : 1567 1572.
61. Tornatore JB, Grant LA. Burden among family caregivers of persons with Alzheimer's disease in nursing homes. Gerontologist 2002 42 : 497 506.
62. Mathew L, Sloan P, Kilby M et al. What's different about a special care unit for dementia patients? A comparative study. Am J Alzheimer Care Rel Dis Res 1988 3 : 16 23.
63. Marcy-Edwards D. Bed rails. Is there an up side? Can Nurse 2005 101 : 30 34.
64. Hughes CM, Lapane KL. Administrative initiatives for reducing inappropriate prescribing of psychotropic drugs in nursing homes: How successful have they been? Drugs Aging 2005 22 : 339 351.
65. Carson S, McDonagh MS, Peterson K. A systematic review of the efficacy and safety of atypical antipsychotis in patients with psychological and behavioral symptoms of dementia. J Am Geriatr Soc 2006 54 : 354 361.
66. Schneider LS, Dagerman K, Insel PS. Efficacy and adverse effects of atypical antipsychotics for dementia: Meta-analysis of randomized, placebo-controlled trials. Am J Geriatr Psychiatry 2006 14 : 191 210.
67. Food and Drug Administration. FDA Public Health Advisory Deaths with antipsychotics in elderly patients with behavioral disturbances [on line]. Available at 2005 Accessed December 3, 2006.
68. Schneider LS, Dagerman KS, Insel PS. Risk of death with atypical antipsychotic drug treatment for dementia. Meta-analysis of randomized placebo-controlled trials. JAMA 2005 294 : 1934 1943.
69. Schneider LS, Tariot PN, Dagerman KS et al. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. N Engl J Med 2006 355 : 1525 1538.
70. Swanson EA, Maas ML, Buckwalter KC. Catastrophic reactions and other behaviors of Alzheimer's residents: Special unit compared with traditional units. Arch Psychiatr Nurs 1993 7 : 292 299.
71. Morris JN, Emerson-Lombardo N. A national perspective on SCU service richness: Findings from the AARP survey. Alzheimer Dis Assoc Dis 1994 8 : S87 S96.
72. Wu N, Miller SC, Lapane K et al. The quality of the quality indicator of pain derived from the Minimum Data Set. Health Serv Res 2005 40 : 1197 1216.