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October 22, 1997, Vol 278, No. 16 >
ARTICLE | October 22, 1997

Effects of Residence in Alzheimer Disease Special Care Units on Functional Outcomes FREE

Charles D. Phillips, PhD, MPH; Philip D. Sloane, MD, MPH; Catherine Hawes, PhD; Gary Koch, PhD; Julie Han, MHS; Kathleen Spry, PhD; George Dunteman, PhD; Rick L. Williams, PhD
JAMA. 1997;278(16):1340-1344. doi:10.1001/jama.1997.03550160060039
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References

Context.  —Alzheimer disease special care units (SCUs) in nursing homes are increasingly prevalent, but little is known about their effects on residents' outcomes.

Objective.  —To analyze the effect of SCU residence on the rates at which residents decline in functional status.

Design.  —A cohort of nursing home residents assessed at multiple points during about 1 year. Facility staff completed all assessments using the Minimum Data Set for Nursing Home Resident Assessment and Care Screening (MDS).

Setting.  —Medicare-or Medicaid-certified nursing facilities.

Patients or Other Participants.  —All nursing home residents in 1993 and early 1994 in Kansas, Maine, Mississippi, and South Dakota. Serial MDS assessments of 77 337 residents in more than 800 facilities, including 1228 residents in 48 facilities with SCUs.

Main Outcome Measures.  —Decline in locomotion, transferring, toileting, eating, dressing, and a summary activities of daily living index; decline in urinary and bowel continence; and significant weight loss.

Results.  —No statistically significant difference was observed in the speed of decline for residents in SCUs and traditional units in any of the 9 outcomes. Residents were matched on a variety of characteristics, and subgroup analyses were performed. In none did we observe a pattern of better outcomes among SCU residents.

Conclusions.  —Although SCUs may have provided unmeasured benefits to families and residents, it does not appear that those benefits included any slowing in the rates of functional decline experienced by individuals with dementia.

REFERENCES

1 +
Zinn JS, Mor V.  Nursing home special care units . Gerontologist . 1994;;34:371-377.
2 +
Mor V, Banaszak-Holl J, Zinn J.  The trend toward specialization in nursing care facilities . Generations . (Winter) 1996;;19:24-29.
3 +
Banaszak-Holl J, Zinn JS, Mor V.  The impact of market and organizational characteristics on nursing facility service innovation: a resource dependency perspective . Health Serv Res . 1996;;31:97-17.
4 +
Office of Technology Assessment. Special Care Units for People With Alzheimer's and Other Dementias: Consumer Education, Research, Regulatory, and Reimbursement Issues . Washington, DC: Office of Technology Assessment; 1992;. Publication OTA-H-543.
5 +
Sloane PD, Lindeman DA, Phillips C, Moritz DJ, Koch G.  Evaluating Alzheimer's special care units . Gerontologist . 1995;;35:103-111.
6 +
Greene JA, Asp J, Crane N.  Specialized management of the Alzheimer's disease patient . J Tenn Med Assoc . 1985;;78:559-563.
7 +
Benson DM, Cameron D, Humbach E, Servine L, Gambert SR.  Establishment and impact of a dementia unit within a nursing home . J Am Geriatr Soc . 1987;;35:319-323.
8 +
Cleary TA, Clamon C, Price M, Shullaw G.  A reduced stimulation unit . Gerontologist . 1988;;28:511-514.
9 +
Hurley AC, Volicer BJ, Hanrahan P, Houde S, Volicer L.  Impact of special care unit for patients with advanced Alzheimer's disease on patients' discomfort and costs . Res Nurs Health . 1992;;15:369-377.
10 +
Swanson EA, Maas ML, Buckwalter KC.  Catastrophic reactions and other behaviors of Alzheimer's residents . Arch Psychiatr Nurs . 1993;;5:292-299.
11 +
Wells Y, Jorn AF.  Evaluation of a special nursing home unit for dementia sufferers . Aust N Z J Psychiatry . 1987;;21:524-531.
12 +
Holmes D, Teresi J, Weiner A, et al.  Impacts associated with special care units in long-term care facilities . Gerontologist . 1990;;30:178-183.
13 +
Chafetz PK.  Behavioral and cognitive outcomes of SCU care . Clin Gerontologist . 1991;;11:19-38.
14 +
Rovner BW, Steele CD, Shmuely Y, Folstein MF.  A randomized trial of dementia care in nursing homes . J Am Geriatr Soc . 1996;;44:7-13.
15 +
Hardwick SE, Pack PJ, Donohoe EA, Aleksa KJ. Across the States, 1994: Profiles of Long-term Care Systems . Washington, DC: American Association of Retired Persons; 1994;.
16 +
Hawes C, Morris JN, Phillips CD, Mor V, Fries BE, Nonemaker S.  Reliability estimates for the Minimum Data Set for Nursing Facility Resident Assessment and Care Screening (MDS) . Gerontologist . 1995;;35:172-178.
17 +
Ohta RJ, Ohta BM.  Special units for Alzheimer's disease patients . Gerontologist . 1988;;28:803-808.
18 +
Hawes C, Greene AM, Wood M, Woodsong C. Family Members' Views: What Is Quality in Assisted Living Facilities Providing Care to People for Dementia? Washington, DC: Alzheimer's Association; 1997;.
19 +
Morris JN, Hawes C, Murphy K, et al. Resident Assessment Instrument Training Manual and Resource Guide . Natick, Mass: Eliot Press; 1991;.
20 +
Phillips CD, Morris JN. The potential use of administrative and clinical data to analyze outcomes for the cognitively impaired. Alzheimer Dis Assoc Disord. In press.
21 +
Morris JN, Fries BE, Mehr D, et al.  MDS Cognitive Performance Scale . J Gerontol Med Sci . 1994;; 49:M174-M182.
22 +
Hartmaier S, Sloane PD, Guess H, Koch GG, Mitchell CM, Phillips CD.  Validation of the Minimum Data Set Cognitive Performance Scale . J Gerontol Med Sci . 1995;;50A:M128-M133.
23 +
Norris-Baker C, Weisman GD, Lawton MP, Sloane PD, Kaup M. Assessing special care units for dementia. In: Steinfeld E, Danford AS, eds. Measuring Enabling Environments. New York, NY: Plenum Publishing Corp. In press.
24 +
Allison PD.  Discrete-time methods for the analysis of event histories . In: Leinhardt S, ed. Sociological Methodology . San Francisco, Calif: Jossey-Bass Publishers Inc; 1982;:61-98.
25 +
Holford TR.  The analysis of rates and survivorship using log-linear models . Biometrics . 1980;;36:299-305.
26 +
Heineman GD.  Negative health outcomes among the elderly . Res Aging . 1985;;7:363-382.
27 +
Aaronson WE, Zinn JS, Rosko MD.  Do for-profit and not-for-profit nursing homes behave differently? Gerontologist . 1994;;34:775-786.
28 +
Braun BI.  The effect of nursing home quality on patient outcome . J Am Geriatr Soc . 1991;;39:329-338.
29 +
Riter RN, Fries BE.  Predictors of the placement of cognitively impaired residents on special care units . Gerontologist . 1992;;32:184-190.
30 +
Green CR, Mohs RC, Schmeidler J, Aryan M, Davis KL.  Functional decline in Alzheimer's disease . J Am Geriatr Soc . 1993;;41:654-661.
31 +
Stark AJ, Kane RL, Kane RA, Finch M.  Effect on physical functioning of care in adult foster homes and nursing homes . Gerontologist . 1995;;35:648-655.
32 +
Rosenbaum PR, Rubin DB.  The central role of the propensity score in observational studies for causal effects . Biometrika . 1983;;70:41-55.
33 +
Shah BV, Barnwell BG, Bieler GS. SUDAAN User's Manual: Release 6.4. 2nd ed. Research Triangle Park, NC: Research Triangle Institute; 1996.
34 +
Advisory Panel on Alzheimer's Disease. Third Report of the Advisory Panel on Alzheimer's Disease. Washington, DC: US Dept of Health and Human Services; 1991. DHHS publication ADM 92-1917.
35 +
Institute of Medicine, Committee on Nursing Home Regulation. Improving the Quality of Nursing Homes . Washington, DC: National Academy Press; 1986;.
36 +
Boling K, Gwyther LP.  Defining the quality of care for nursing home residents with dementia . In: Sloane PD, Mathew LJ, eds. Dementia Units in Long-term Care . Baltimore, Md: Johns Hopkins University Press; 1991;:3-22.
37 +
Office of Technology Assessment. Losing a Million Minds: Confronting the Tragedy of Alzheimer's Disease and Other Dementias . Washington, DC: Office of Technology Assessment; 1987;. OTA report OTA-BA-323.
38 +
Alzheimer's Disease and Related Disorders Association. Guidelines for Dignity: Goals of Specialized Alzheimer/Dementia Care in Residential Settings . Chicago, Ill: Alzheimer's Disease and Related Disorders Association; 1992;.
39 +
Joint Commission on the Accreditation of Healthcare Organizations. Standards and Survey Protocol for Dementia Special Care Units . Oakbrook Terrace, Ill: Joint Commission on the Accreditation of Healthcare Organizations; 1993;.
40 +
Mathew L, Sloane P, Kilby M, Flood R.  What's different about a special care unit for dementia patients? Am J Alzheimer Care Rel Disord Res . 1988;; 3:16-23.
41 +
Sloane PD, Mathew LJ, Scarborough M, Desai JR, Koch GG, Tangen C.  Physical and pharmacologic restraint in nursing home patients with dementia . JAMA . 1991;;265:1278-1282.
42 +
Mehr DR, Fries BE.  Resource use on Alzheimer's special care units . Gerontologist . 1995;;35:179-184.
43 +
Gold DT, Sloane PD, Mathew LJ, Bledsoe MM, Konanc DA.  Special care units . Gerontologist . 1991;;31:467-475.
44 +
Grant LA, Kane RA, Stark AJ.  Beyond labels . J Am Geriatr Soc . 1995;;43:569-576.

Figures

Tables

Interactive Graphics

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Zinn JS, Mor V.  Nursing home special care units . Gerontologist . 1994;;34:371-377.
2 +
Mor V, Banaszak-Holl J, Zinn J.  The trend toward specialization in nursing care facilities . Generations . (Winter) 1996;;19:24-29.
3 +
Banaszak-Holl J, Zinn JS, Mor V.  The impact of market and organizational characteristics on nursing facility service innovation: a resource dependency perspective . Health Serv Res . 1996;;31:97-17.
4 +
Office of Technology Assessment. Special Care Units for People With Alzheimer's and Other Dementias: Consumer Education, Research, Regulatory, and Reimbursement Issues . Washington, DC: Office of Technology Assessment; 1992;. Publication OTA-H-543.
5 +
Sloane PD, Lindeman DA, Phillips C, Moritz DJ, Koch G.  Evaluating Alzheimer's special care units . Gerontologist . 1995;;35:103-111.
6 +
Greene JA, Asp J, Crane N.  Specialized management of the Alzheimer's disease patient . J Tenn Med Assoc . 1985;;78:559-563.
7 +
Benson DM, Cameron D, Humbach E, Servine L, Gambert SR.  Establishment and impact of a dementia unit within a nursing home . J Am Geriatr Soc . 1987;;35:319-323.
8 +
Cleary TA, Clamon C, Price M, Shullaw G.  A reduced stimulation unit . Gerontologist . 1988;;28:511-514.
9 +
Hurley AC, Volicer BJ, Hanrahan P, Houde S, Volicer L.  Impact of special care unit for patients with advanced Alzheimer's disease on patients' discomfort and costs . Res Nurs Health . 1992;;15:369-377.
10 +
Swanson EA, Maas ML, Buckwalter KC.  Catastrophic reactions and other behaviors of Alzheimer's residents . Arch Psychiatr Nurs . 1993;;5:292-299.
11 +
Wells Y, Jorn AF.  Evaluation of a special nursing home unit for dementia sufferers . Aust N Z J Psychiatry . 1987;;21:524-531.
12 +
Holmes D, Teresi J, Weiner A, et al.  Impacts associated with special care units in long-term care facilities . Gerontologist . 1990;;30:178-183.
13 +
Chafetz PK.  Behavioral and cognitive outcomes of SCU care . Clin Gerontologist . 1991;;11:19-38.
14 +
Rovner BW, Steele CD, Shmuely Y, Folstein MF.  A randomized trial of dementia care in nursing homes . J Am Geriatr Soc . 1996;;44:7-13.
15 +
Hardwick SE, Pack PJ, Donohoe EA, Aleksa KJ. Across the States, 1994: Profiles of Long-term Care Systems . Washington, DC: American Association of Retired Persons; 1994;.
16 +
Hawes C, Morris JN, Phillips CD, Mor V, Fries BE, Nonemaker S.  Reliability estimates for the Minimum Data Set for Nursing Facility Resident Assessment and Care Screening (MDS) . Gerontologist . 1995;;35:172-178.
17 +
Ohta RJ, Ohta BM.  Special units for Alzheimer's disease patients . Gerontologist . 1988;;28:803-808.
18 +
Hawes C, Greene AM, Wood M, Woodsong C. Family Members' Views: What Is Quality in Assisted Living Facilities Providing Care to People for Dementia? Washington, DC: Alzheimer's Association; 1997;.
19 +
Morris JN, Hawes C, Murphy K, et al. Resident Assessment Instrument Training Manual and Resource Guide . Natick, Mass: Eliot Press; 1991;.
20 +
Phillips CD, Morris JN. The potential use of administrative and clinical data to analyze outcomes for the cognitively impaired. Alzheimer Dis Assoc Disord. In press.
21 +
Morris JN, Fries BE, Mehr D, et al.  MDS Cognitive Performance Scale . J Gerontol Med Sci . 1994;; 49:M174-M182.
22 +
Hartmaier S, Sloane PD, Guess H, Koch GG, Mitchell CM, Phillips CD.  Validation of the Minimum Data Set Cognitive Performance Scale . J Gerontol Med Sci . 1995;;50A:M128-M133.
23 +
Norris-Baker C, Weisman GD, Lawton MP, Sloane PD, Kaup M. Assessing special care units for dementia. In: Steinfeld E, Danford AS, eds. Measuring Enabling Environments. New York, NY: Plenum Publishing Corp. In press.
24 +
Allison PD.  Discrete-time methods for the analysis of event histories . In: Leinhardt S, ed. Sociological Methodology . San Francisco, Calif: Jossey-Bass Publishers Inc; 1982;:61-98.
25 +
Holford TR.  The analysis of rates and survivorship using log-linear models . Biometrics . 1980;;36:299-305.
26 +
Heineman GD.  Negative health outcomes among the elderly . Res Aging . 1985;;7:363-382.
27 +
Aaronson WE, Zinn JS, Rosko MD.  Do for-profit and not-for-profit nursing homes behave differently? Gerontologist . 1994;;34:775-786.
28 +
Braun BI.  The effect of nursing home quality on patient outcome . J Am Geriatr Soc . 1991;;39:329-338.
29 +
Riter RN, Fries BE.  Predictors of the placement of cognitively impaired residents on special care units . Gerontologist . 1992;;32:184-190.
30 +
Green CR, Mohs RC, Schmeidler J, Aryan M, Davis KL.  Functional decline in Alzheimer's disease . J Am Geriatr Soc . 1993;;41:654-661.
31 +
Stark AJ, Kane RL, Kane RA, Finch M.  Effect on physical functioning of care in adult foster homes and nursing homes . Gerontologist . 1995;;35:648-655.
32 +
Rosenbaum PR, Rubin DB.  The central role of the propensity score in observational studies for causal effects . Biometrika . 1983;;70:41-55.
33 +
Shah BV, Barnwell BG, Bieler GS. SUDAAN User's Manual: Release 6.4. 2nd ed. Research Triangle Park, NC: Research Triangle Institute; 1996.
34 +
Advisory Panel on Alzheimer's Disease. Third Report of the Advisory Panel on Alzheimer's Disease. Washington, DC: US Dept of Health and Human Services; 1991. DHHS publication ADM 92-1917.
35 +
Institute of Medicine, Committee on Nursing Home Regulation. Improving the Quality of Nursing Homes . Washington, DC: National Academy Press; 1986;.
36 +
Boling K, Gwyther LP.  Defining the quality of care for nursing home residents with dementia . In: Sloane PD, Mathew LJ, eds. Dementia Units in Long-term Care . Baltimore, Md: Johns Hopkins University Press; 1991;:3-22.
37 +
Office of Technology Assessment. Losing a Million Minds: Confronting the Tragedy of Alzheimer's Disease and Other Dementias . Washington, DC: Office of Technology Assessment; 1987;. OTA report OTA-BA-323.
38 +
Alzheimer's Disease and Related Disorders Association. Guidelines for Dignity: Goals of Specialized Alzheimer/Dementia Care in Residential Settings . Chicago, Ill: Alzheimer's Disease and Related Disorders Association; 1992;.
39 +
Joint Commission on the Accreditation of Healthcare Organizations. Standards and Survey Protocol for Dementia Special Care Units . Oakbrook Terrace, Ill: Joint Commission on the Accreditation of Healthcare Organizations; 1993;.
40 +
Mathew L, Sloane P, Kilby M, Flood R.  What's different about a special care unit for dementia patients? Am J Alzheimer Care Rel Disord Res . 1988;; 3:16-23.
41 +
Sloane PD, Mathew LJ, Scarborough M, Desai JR, Koch GG, Tangen C.  Physical and pharmacologic restraint in nursing home patients with dementia . JAMA . 1991;;265:1278-1282.
42 +
Mehr DR, Fries BE.  Resource use on Alzheimer's special care units . Gerontologist . 1995;;35:179-184.
43 +
Gold DT, Sloane PD, Mathew LJ, Bledsoe MM, Konanc DA.  Special care units . Gerontologist . 1991;;31:467-475.
44 +
Grant LA, Kane RA, Stark AJ.  Beyond labels . J Am Geriatr Soc . 1995;;43:569-576.

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