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Cited by 60Palliative Care and End-of-Life IssuesGeriatric Care and Nursing HomesDementia and Cognitive Impairment Research

The DOI matches its Crossref record; 25 of the 25 references it cites were found in a registry or an index.

The Quality of Advanced Dementia Care in the Nursing Home: The Role of Special Care Units

Open access
Cadigan, Rebecca Orfaly, Grabowski, David C., Givens, Jane L., Mitchell, Susan L.·2012·Medical Care
DOI 10.1097/mlr.0b013e31825dd713PMC PMC3444818
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Abstract

BACKGROUND: The quality of nursing home care for residents with advanced dementia has been described as suboptimal. One relatively understudied factor is the impact of special care units (SCUs) for dementia for residents at the end stage of this disease. OBJECTIVE: To examine the association between residence in an SCU and the quality of end-of-life care for nursing home residents with advanced dementia. RESEARCH DESIGN: This study used longitudinal data on 323 nursing home residents with advanced dementia living in 22 Boston-area facilities. Using multivariate methods, we analyzed the association between residence in an SCU and measures of quality of end-of-life care including: treatment of pain and dyspnea, prevalence of pressure ulcers, hospitalization, tube feeding, antipsychotic drug use, advance care planning, and health care proxy (HCP) satisfaction with care. RESULTS: A total of 43.7% residents were cared for in an SCU. After multivariate adjustment, residents in SCUs were more likely to receive treatment for dyspnea, had fewer hospitalizations, were less likely to be tube fed, and more likely to have a do-not-hospitalize order, compared with non-SCU residents. However, non-SCU residents were more likely to be treated for pain, had fewer pressure ulcers, and less frequent use of antipsychotic drugs than SCU residents. HCPs of SCU residents reported greater satisfaction with care than HCPs of non-SCU residents. CONCLUSIONS: Residence in an SCU is associated with some, but not all, markers of better quality end-of-life care among nursing home residents with advanced dementia.

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Crossref · 10.1097/mlr.0b013e31825dd713

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  • Eighty-six percent of the studies included patients with different types of dementia, but the remaining 14% investigated only patients with Alzheimer's disease.

    “Eighty-six percent of the studies included patients with different types of dementia, but the remaining 14% investigated only patients with Alzheimer's disease [35,38,41].”

    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 [38]

    The Methods (Study Sample; page unavailable) say this study accepted residents with dementia of any type, so it can exemplify a study not restricted to Alzheimer’s disease. The paper does not report the claimed 86%–14% breakdown across studies or establish which studies investigated only Alzheimer’s disease. (LLM, conf=0.85)

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  • A possible explanation for the lack of clear direction in ADL differences is that the studies looked at different functional abilities or levels of disability.

    “A possible explanation is that the studies looked at different functional abilities, e.g. transferring, eating, toileting, dressing and bathing [8] or levels of disability [38].”

    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 [38]

  • Two studies showed large or small effect sizes indicating that patients living in SCUs had better psychosocial function compared to n-SCU patients.

    “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.”

    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 [38]

    The Methods (Statistical Analysis; page unavailable) list end-of-life care outcomes, not psychosocial function. The Results compare SCU and non-SCU residents on those outcomes but do not report a small effect size for psychosocial function. Searches for psychosocial function and related terms found no supporting passage in our copy. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • A 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 [38]

    Citation [43] is attached to the claim that this study found significantly greater global cognitive impairment in SCU residents than in non-SCU residents. The Results section on baseline characteristics reports a high level of functional disability in the overall sample, but the passages found do not compare cognitive impairment between the groups or give a significance value for it. Searches for cognitive impairment, cognitive scores, and SCU comparisons found no passage establishing that result. (LLM, conf=0.72)

    Experimental — accuracy not yet measured

  • Five studies showed better ADL or functional abilities for the n-SCU group compared to SCUs with large, small and very small effect sizes or p values.

    “Five studies showed better ADL or functional abilities, e.g. self-care, for the n-SCU group with large [38], small [33] and very small [20,31] effect sizes or 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 [38]

    The Results section on baseline characteristics reports a high level of functional disability for the sample overall, but does not say that non-SCU residents had better ADL or functional abilities than SCU residents. The Methods section lists the compared outcomes without ADL or functional ability; searches for ADL, self-care, and BANS-S found no relevant group comparison or p value. No page numbers were available in our copy. (LLM, conf=0.72)

    Experimental — accuracy not yet measured

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Metadata

Authors
Cadigan, R. O., Grabowski, D. C., Givens, J. L., & Mitchell, S. L.
Affiliations
  • Harvard University (US)
  • Beth Israel Deaconess Medical Center (US)
Corresponding author
  • Cadigan, Rebecca Orfaly
  • Grabowski, David C.
  • Givens, Jane L.
  • Mitchell, Susan L.
ORCID
Grabowski, David C.
Venue
Medical Care
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2012-10
Volume
50
Issue
10
Pages
856-862
ISSN
0025-7079 (ISSN-L)
DOI
10.1097/mlr.0b013e31825dd713
PMC
PMC3444818
OpenAlex
W1985597330
Cited by
60
References
25
Citations by year
2026: 2 · 2025: 2 · 2024: 3 · 2023: 10 · 2022: 2 · 2021: 7 · 2020: 6 · 2019: 3 · 2018: 7 · 2017: 2 · 2016: 3 · 2015: 4 · 2014: 3 · 2013: 6
FWCI
4.02
Type
journal article
Language
en
Open access
Locations
  • Medical Care (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Aging (K23AG034967, R01AG024091, K24AG033640)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Geriatrics and Gerontology › Geriatric Care and Nursing Homes
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Keywords
advanced dementia, nursing homes, special care units, end-of-life care, quality of care, pain management, dyspnea management, pressure ulcers, hospitalization, tube feeding, antipsychotic drug use, advance care planning, long-term care
MeSH terms
Aged, Aged, 80 and over, Pressure Ulcer, Dementia, Female, Health Services, Homes for the Aged, Hospitalization, Humans, Longitudinal Studies, Male, Nursing Homes, Quality of Health Care, Severity of Illness Index, Socioeconomic Factors, Terminal Care, Advance Directives, Quality Indicators, Health Care

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