Dementia and Assisted Living

Abstract

Purpose: This article presents an overview of what is known about dementia services in assisted living settings and suggests areas for future research. Design and Methods: We undertook a search of Medline, the Journals of Gerontology, and The Gerontologist. We then organized publications dealing with the target subject into 10 topic areas and reviewed them. Results: The article describes the demographic characteristics of cognitively impaired residents in assisted living and related residential settings in the United States, the services they receive, and process and structural elements both in specialized dementia units and in integrated assisted living settings. Finally, we review the literature on methodological issues regarding research in this area. Implications: It is important to generate research on processes as well as outcomes, such as dignity, individualized and pleasurable experiences, and freedom from pain and discomfort. We make recommendations for both content areas that would benefit from further research as well as methodological approaches that will yield important information in this field.Key Words: Long-term care, Alzheimer's disease, Cognitively impaired, Aging in place, Residential careThis article outlines what is known about dementia services in assisted living settings and explores the many questions that remain unanswered. Ultimately, research is needed that will offer specific information regarding how assisted living processes and structure result in specific outcomes in the various subpopulations of cognitively impaired residents. The variability of assisted living and its philosophy of customizing services to the wishes and needs of each individual resident provide a rich environment for research as researchers attempt to discover what works best for whom (Feldman & Kane, 2003). We also discuss the range of processes and outcomes that one should consider in evaluating the effectiveness of assisted living services and environments, including the central role of quality of life in the assisted living philosophy of dementia care.Assisted living, as an industry, is less than 20 years old. Early research sought to enumerate how many people with dementia lived in assisted living, how many were in special care units (SCUs) or in general assisted living settings, and what kinds of services they received. However, even these simple facts have been elusive as basic data such as the prevalence of dementia can be difficult to determine in these non-health-care settings. In fact, determining which settings meet the criteria to be considered assisted living can, in itself, be less than straightforward.Central to the assisted living philosophy is a respect for the individuals who live in this setting and their continued rights as citizens and human beings. However, this philosophy is challenged when the people served have cognitive impairments that compromise their ability to make or communicate decisions regarding their care and lifestyle choices.Not all regulators, providers, family members, co...

The Enriched Opportunities Programme for people with dementia: A cluster-randomised controlled trial in 10 extra care housing schemes

“…Research with people with dementia in extra care housing is a relatively new field of endeavour (Hyde et al, 2007). Outcome measures in this context are in development.…”

“…In the United States the term assisted living settings is used. In a review of research on assisted living (Hyde, Perez, & Forrester, 2007) highlighted that networks of researchers in this area are relatively new when compared to care home research and that there are significant methodological and practical issues to overcome. They concluded that much of what we know from research into care practices for people with dementia in community and nursing home settings needs to be replicated and new types of research undertaken in assisted living settings.…”

Resident interactions at mealtime: an exploratory study

“…Under a predominately social model (Hyde et al 2007), residents receive meals and medication oversight as well as a private or shared room; assistance with bathing may be offered on a limited basis. Residents are able to manage self-grooming and toileting, although they often require mobility aides.…”

“…Quality of life is a primary outcome for these residents, and mealtimes including quality of food and tablemate fellowship play a significant role (Hopper et al 2007;Street et al 2007). However, more research is required to understand what influences quality of life in these care settings as they are currently understudied (Hyde et al 2007).…”

“…To date, research has primarily focussed on studying mealtime interactions amongst residents and staff in nursing homes where capacity for interaction may be limited due to health concerns (Dubé et al 2007;Nijs et al 2006). Tablemates and their potential for interaction and fellowship appear to be important to adjustment as well as quality of life of residents (Reed and Roskell Payton 1996); yet, it is unclear what types and frequency of social interaction occur in the retirement home, as research in this setting is scant (Hyde et al 2007). As this is often the first point of transition to residential care for older adults, it is important to understand what are the social interactions that occur in this setting and what influences them (Hubbard et al 2003).…”