Health and Functional Outcomes and Health Care Utilization of Persons With Dementia in Residential Care and Assisted Living Facilities: Comparison With Nursing Homes
Abstract
PURPOSE: This study compares health and functional outcomes and health care utilization of persons with dementia residing in residential care/assisted living (RC/AL) facilities and nursing homes. DESIGN AND METHODS: The study uses data from a longitudinal cohort study of 1,252 residents with dementia in 106 RC/AL facilities and 40 nursing homes in four states. RESULTS: Rates of mortality; new or worsening morbidity; and change in activities of daily living, cognition, behavioral problems, depressive symptoms, social function, and withdrawal did not differ between the two settings. However, because of death or transfer, only about one half of the persons with mild dementia and one third of those with moderate to severe dementia remained in RC/AL facilities 1 year after enrollment. In addition, hospitalization rates were greater among individuals with mild dementia in RC/AL facilities, largely because of a medically unstable subgroup with high nursing-home-transfer rates. IMPLICATIONS: Many persons with dementia can be served equally well in either setting; however, those with major medical care needs may benefit from nursing home residence.
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One study showed a large effect size for better washing, a moderate effect size for better dressing and small effect sizes for better feeding, toileting and mobility for the SCU group compared to the n-SCU group.
“More specifically, 1 study [28] showed a large effect size for better washing, a moderate effect size for better dressing and small effect sizes for better feeding, toileting and mobility for the SCU group compared to the n-SCU group.”
From Special Care Units and Traditional Care in Dementia: Relationship with Behavior, Cognition, Functional Status and Quality of Life - A Review (2013) · cites this paper as [28]
The Residence in Specialized Units section (page not provided) reports more rapid ADL decline in special care units than in nonspecialized settings in residential care/assisted living, and no such association in nursing homes. The Discussion (page not provided) likewise reports little overall difference between the settings. Neither section supports the claimed pattern of better washing, dressing, feeding, toileting, and mobility or its effect-size classifications. (LLM, conf=0.87)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredOne study showed more aggression in the n-SCU group compared to SCUs, with a small effect size.
“One study showed more aggression in the n-SCU group, with a small effect size [28].”
From Special Care Units and Traditional Care in Dementia: Relationship with Behavior, Cognition, Functional Status and Quality of Life - A Review (2013) · cites this paper as [28]
The Residence in Specialized Units section reports no significant difference in changes in behavioral problems between special care units and nonspecialized settings. The Discussion’s small standardized effect sizes (0.2–0.3) describe differences the study could detect, not an observed aggression difference. Our copy does not report greater aggression in the nonspecialized group. (LLM, conf=0.78)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredActivity disturbance with a small effect size was more common in the SCU group compared to the n-SCU group in one study.
“Activity disturbance with a small effect size was more common in another study [28].”
From Special Care Units and Traditional Care in Dementia: Relationship with Behavior, Cognition, Functional Status and Quality of Life - A Review (2013) · cites this paper as [28]
The Residence in Specialized Units section reports no significant difference between special care units and nonspecialized settings in changes in behavioral problems or withdrawal. The Discussion describes 0.2–0.3 as effect sizes the study could detect, not an observed increase in activity disturbance. (LLM, conf=0.87)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredA large effect size for better communication and recognition and a small effect size for better orientation in the SCU group compared to the n-SCU group were found.
“A large effect size for better communication and recognition and a small effect size for better orientation in the SCU group compared to the n-SCU group were also found [28].”
From Special Care Units and Traditional Care in Dementia: Relationship with Behavior, Cognition, Functional Status and Quality of Life - A Review (2013) · cites this paper as [28]
The ‘Residence in Specialized Units’ section compares special care units with nonspecialized settings but does not report communication, recognition, or orientation outcomes. The Discussion mentions effect sizes of 0.2–0.3 only as differences the study could have detected, not as observed effects. Searches for communication, recognition, orientation, and the claimed effect sizes found no passage establishing this claim. (LLM, conf=0.73)
Experimental — accuracy not yet measuredA greater global cognitive impairment in the SCU group compared to n-SCUs was found in 10 studies with large, moderate and small effect sizes or significant p values.
“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].”
From Special Care Units and Traditional Care in Dementia: Relationship with Behavior, Cognition, Functional Status and Quality of Life - A Review (2013) · cites this paper as [28]
Table 1 (Discussion; page unavailable) reports a significant cognition difference between nursing homes and residential care/assisted living facilities, not between special care units (SCUs) and nonspecialized settings. The Residence in Specialized Units section compares changes in cognition but reports no significant difference; our copy does not provide the claimed significant comparison of global cognitive impairment at baseline. (LLM, conf=0.75)
Experimental — accuracy not yet measured
Three studies showed large or small effect sizes suggesting more depressive symptoms in the SCU population at baseline compared to n-SCUs.
“Three studies showed a large [34] and a small [20,28] effect size, suggesting more depressive symptoms in the SCU population at baseline.”
From Special Care Units and Traditional Care in Dementia: Relationship with Behavior, Cognition, Functional Status and Quality of Life - A Review (2013) · cites this paper as [28]
Table 1 (Discussion; page unavailable) gives enrollment depression scores by facility type—residential care/assisted living versus nursing homes—not by special-care-unit status. The Residence in Specialized Units section compares changes in depression between special-care units and nonspecialized settings, but does not report their baseline depression scores or an effect size. Searches for baseline depressive symptoms in those settings found no comparison supporting the cited claim. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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Self-citation
- Authors
- Sloane, P. D., Zimmerman, S., Gruber-Baldini, A. L., Hebel, J. R., Magaziner, J., & Konrad, T. R.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- University of Maryland, Baltimore (US)
- Corresponding author
- Sloane, Philip D.
- Venue
- The Gerontologist
- Publisher
- Oxford University Press (OUP)
- Published
- 2005-10
- Volume
- 45
- Issue
- suppl_1
- Pages
- 124-134
- ISSN
- 0016-9013 (ISSN-L)
- 1758-5341
- OpenAlex
- W2102023377
- Semantic Scholar
- 7bf82945e5e7fbd2338e94e50c1a3b63d5cd5081
- Cited by
- 87
- References
- 36
- Citations by year
- 2026: 3 · 2024: 2 · 2023: 4 · 2022: 3 · 2021: 2 · 2020: 8 · 2019: 5 · 2018: 4 · 2017: 5 · 2016: 3 · 2015: 6 · 2014: 7 · 2013: 7 · 2012: 4
- FWCI
- 9.09
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Gerontologist (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging
- Topics
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- dementia, residential care, assisted living, nursing homes, health care utilization, functional outcome, activities of daily living, hospitalization, nursing home transfer, mortality, behavioral problems, depressive symptoms, social function
- MeSH terms
- Aged, 80 and over, Delivery of Health Care, Dementia, Female, Humans, Longitudinal Studies, Male, Nursing Homes, Residential Facilities, Cohort Studies, Outcome Assessment, Health Care, Assisted Living Facilities
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