Innovative Dementia Care: Functional Status over Time of Persons with Alzheimer Disease in a Residential Care Centre Compared to Special Care Units

Abstract

Residential care centres (RCCs) for persons with Alzheimer disease are increasing worldwide, but there are few studies that compare the functional outcomes of RCC residents to residents of other types of continuing care settings. This study compared residents of the first Canadian RCC on physical, cognitive, behavioural and emotional functioning 6, 12 and 18 months after admission to residents of special care units (SCUs) operated by the same continuing care provider. SCU residents were initially functioning lower than RCC residents on most outcome measures and these differences persisted over time. Resident functioning declined over time regardless of care setting and, when the initial status was controlled for, the rates of decline were similar. However, RCC residents experienced greater independence/freedom of choice, fewer physical or psychotropic medication restraints and were more active, which may have enhanced their quality of life.

Special Care Units and Traditional Care in Dementia: Relationship with Behavior, Cognition, Functional Status and Quality of Life - A Review

“…A greater global cognitive impairment in the SCU group was found in 10 studies with large [33,38,39,42], moderate [20,28,36] and small effect sizes [21,34] or significant p values [43]. In contrast, 1 study showed an increased cognitive impairment with a large effect size in a limited number of participants [35], and 1 study showed a moderate effect size in a younger n-SCU patient group [9].…”

“…In 1 of them, the calculated effect size at baseline was nil for social activities such as going to the barber and social withdrawal [32], and in another paper, no significant p value was found for participation in pleasant events and social withdrawal [14]. Two studies showed large [38] or small [20] effect sizes, implying that patients living in the SCU showed a better psychosocial function compared to n-SCU patients. One study [15] showed a moderate effect size, indicating a distinct psychosocial behavior in a small patient population from a small-scale, homelike SCU compared to patients from an n-SCU.…”

“…In 4 of them, a nil effect size [32,38] or a significant p value [26,39] were found. Three studies showed a large [34] and a small [20,28] effect size, suggesting more depressive symptoms in the SCU population at baseline.…”

“…self-care, for the n-SCU group with large [38], small [33] and very small [20,31] effect sizes or p values [43]. …”

Small, homelike care environments for older people with dementia: a literature review

“…Special Care Facility: Reimer et al, 2004;Slaughter et al, 2006. "Woodside": Arehart-Treichel, 2001;Danes, 2002;Janzen, 2000;McAllister and Silverman, 1999;Nagy, 2002;Saxton et al, 1998;Warren et al, 2001;2002. ADL = activities of daily living; CPS = Cognitive Performance Scales; GDS = Global Deterioration Scale; MDS = minimum data sets; MMSE = Mini-mental State Examination.…”