Is dementia special care really special? A new look at an old question.
OBJECTIVE
To quantify differences in care provided to nursing home (NH) residents with dementia living on and off dementia special care units (SCUs).


METHODS
Cross-sectional study using propensity score adjustment for resident and NH characteristics.


METHODS
Free-standing NHs in nonrural U.S. counties that had an SCU in 2004 (N=1,896).


METHODS
Long-stay (> or = 90 days) NH residents with a diagnosis of Alzheimer's disease or dementia and at least moderate cognitive impairment (N=69,131).


METHODS
Resident-level NH care processes such as physical restraints, bed rails, feeding tubes, psychotropic medications, and incontinence care.


RESULTS
There was no difference in the use of physical restraints (adjusted odds ratio (AOR)=0.94, 95% confidence interval (CI)=0.79-1.11), but SCU residents were less likely to have had bed rails (AOR=0.55, 95% CI=0.46-0.64) and to have been tube fed (AOR=0.36, 95% CI=0.30-0.43). SCU residents were more likely to be on toileting plans (AOR=1.23, 95% CI=1.08-1.39) and less likely to use pads or briefs in the absence of a toileting plan (AOR=0.73, 95% CI=0.61-0.88). SCU residents were more likely to have received psychotropic medications (AOR=1.23, 95% CI=1.05-1.44), primarily antipsychotics (SCU=44.9% vs non-SCU=30.0%).


CONCLUSIONS
SCU residents received different care than comparable non-SCU residents. Most strikingly, SCU residents had greater use of antipsychotic medications.
Gruneir
Andrea
A
Department of Community Health, Brown University, Providence, Rhode Island, USA. agruneir@klaru-baycrest.on.ca
Lapane
Kate L
KL
Miller
Susan C
SC
Mor
Vincent
V
D003430:Cross-Sectional Studies; D003704:Dementia / Q000451:nursing*; D005260:Female; D006299:Health Services for the Aged / Q000458:organization & administration*; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000458:organization & administration*; D010043:Outcome and Process Assessment, Health Care; D012044:Regression Analysis; D014481:United States