Alzheimer special care units compared with traditional nursing home for dementia care: are there differences at admission and in clinical outcomes?
BACKGROUND
Studies comparing Alzheimer Special Care Units (ASCUs) with traditional nursing homes (NHs) have reported conflicting results.


OBJECTIVE
To compare the characteristics and the effects on mortality, hospitalization, use of physical restraints, falls, and antipsychotics among patients admitted to ASCUs or to NHs.


METHODS
A sequential cohort of patients with dementia was recruited and followed for 18 months in a sample of randomly selected ASCUs and NHs. Data on socio-demographic, cognitive, functional, behavioral, and clinical characteristics, and drug exposure were collected at baseline and at 6-month intervals up to 18 months.


RESULTS
A total of 349 patients were enrolled in 35 ASCUs and 81 in 9 NHs. Patients admitted to ASCUs were younger, cognitively and functionally less impaired, but had more behavioral disturbances than those in NH. During follow-up, ASCU patients had a lower risk of hospitalization (odds ratio: 0.67; 95% confidence interval: 0.46-0.99; P=0.04), and use of physical restraints (odds ratio: 0.66; 95% confidence interval: 0.51-0.86; P=0.003), and showed a higher rate of withdrawal of antipsychotics (P=0.003). No difference was found in mortality and falls. Propensity score analysis gives similar results.


CONCLUSIONS
This study found that patients with dementia in ASCUs had different baseline clinical and functional characteristics from those in NHs. They had a lower rate of hospitalization and use of physical restraints at 6-month follow-up, and a higher probability of having antipsychotic agents withdrawn.
Nobili
Alessandro
A
Laboratory of Quality Assessment of Geriatric Therapies and Services for the Elderly, Lombardy Region, Italy. nobili@marionegri.it
Piana
Ilaria
I
Balossi
Laura
L
Pasina
Luca
L
Matucci
Marina
M
Tarantola
Massimo
M
Trevisan
Silvia
S
Riva
Emma
E
Lucca
Ugo
U
Tettamanti
Mauro
M
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy / Q000451:nursing*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003704:Dementia / Q000451:nursing*; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008609:Mental Status Schedule; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D011788:Quality of Life; D012149:Restraint, Physical / Q000706:statistics & numerical data; D016896:Treatment Outcome
D014150:Antipsychotic Agents