title: Impact of special care unit for patients with advanced Alzheimer's disease on patients' discomfort and costs.
abstract: OBJECTIVE
  To compare outcomes in patients with the clinical diagnosis of probable dementia of the Alzheimer type (DAT) cared for in a Dementia Special Care Unit (DSCU) with those in traditional long-term care (TLTC).
  
  
  METHODS
  Two-year prospective cohort study.
  
  
  METHODS
  Two Veterans Administration Hospitals. The DSCU concentrated on assuring patients' comfort instead of promoting maximal survival; in some patients this excluded transfer to acute medical settings, the use of antibiotics, and tube feeding.
  
  
  METHODS
  Data were collected regarding disease severity, patient discomfort, use of medical resources, and mortality rate.
  
  
  RESULTS
  Patients at both settings were similar on baseline measures, and most were severely demented. The monthly levels of observed discomfort were lower in DSCU than in TLTC patients. The costs of medications, radiology, and laboratory procedures were lower in DSCU than in TLTC patients. DSCU patients were also transferred less frequently to an acute medical setting. The average 3-month cost for a DSCU patient was $1477 less than the cost of care for a TLTC patient. However, DSCU patients with lower severity of DAT had a higher mortality rate then TLTC patients.
  
  
  CONCLUSIONS
  These results suggest that management of patients with advanced DAT on a DSCU using a palliative care philosophy may result in less patient discomfort and lower costs than management on a TLTC.
authors.affiliation: E.N. Rogers Memorial Veterans Hospital, Geriatric Research Education Clinical Center, Bedford, MA 01730.
authors.forename: L
authors.initials: L
authors.lastname: Volicer
authors.forename: A
authors.initials: A
authors.lastname: Collard
authors.forename: A
authors.initials: A
authors.lastname: Hurley
authors.forename: C
authors.initials: C
authors.lastname: Bishop
authors.forename: D
authors.initials: D
authors.lastname: Kern
authors.forename: S
authors.initials: S
authors.lastname: Karon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006757:Hospital Units / Q000458:organization & administration*; D006787:Hospitals, Veterans / Q000458:organization & administration; D006801:Humans; D008134:Long-Term Care / Q000191:economics / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000191:economics*; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States