Alzheimer special care units compared with traditional nursing home for dementia care: Are there differences at admission and in clinical outcomes?

Alessandro Nobili, Ilaria Piana, Laura Balossi, Luca Pasina, Marina Matucci, Massimo Tarantola, Silvia Trevisan, Emma Riva, Ugo Lucca, Mauro Tettamanti

Research output: Contribution to journalArticle

Abstract

Background: Studies comparing Alzheimer Special Care Units (ASCUs) with traditional nursing homes (NHs) have reported conflicting results. Objectives: 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and use of physical restraints at 6-month follow-up, and a higher probability of having antipsychotic agents withdrawn.

Original languageEnglish
Pages (from-to)352-361
Number of pages10
JournalAlzheimer Disease and Associated Disorders
Volume22
Issue number4
DOIs
Publication statusPublished - Oct 2008

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Home Care Services
Nursing Homes
Dementia
Physical Restraint
Antipsychotic Agents
Hospitalization
Odds Ratio
Confidence Intervals
Propensity Score
Mortality
Patient Care
Alzheimer Disease
Demography
Pharmaceutical Preparations

Keywords

  • Behavioral disturbances
  • Dementia
  • Nursing home
  • Quality of care
  • Special care unit

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Psychiatry and Mental health
  • Gerontology
  • Clinical Psychology

Cite this

Alzheimer special care units compared with traditional nursing home for dementia care : Are there differences at admission and in clinical outcomes? / Nobili, Alessandro; Piana, Ilaria; Balossi, Laura; Pasina, Luca; Matucci, Marina; Tarantola, Massimo; Trevisan, Silvia; Riva, Emma; Lucca, Ugo; Tettamanti, Mauro.

In: Alzheimer Disease and Associated Disorders, Vol. 22, No. 4, 10.2008, p. 352-361.

Research output: Contribution to journalArticle

Nobili, Alessandro ; Piana, Ilaria ; Balossi, Laura ; Pasina, Luca ; Matucci, Marina ; Tarantola, Massimo ; Trevisan, Silvia ; Riva, Emma ; Lucca, Ugo ; Tettamanti, Mauro. / Alzheimer special care units compared with traditional nursing home for dementia care : Are there differences at admission and in clinical outcomes?. In: Alzheimer Disease and Associated Disorders. 2008 ; Vol. 22, No. 4. pp. 352-361.
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AU - Pasina, Luca

AU - Matucci, Marina

AU - Tarantola, Massimo

AU - Trevisan, Silvia

AU - Riva, Emma

AU - Lucca, Ugo

AU - Tettamanti, Mauro

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AB - Background: Studies comparing Alzheimer Special Care Units (ASCUs) with traditional nursing homes (NHs) have reported conflicting results. Objectives: 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.

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KW - Quality of care

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