Special care units for dementia in nursing homes: A controlled study of effectiveness

The management of behavioral disturbances in the demented patient is a debated issue both in the medical and the social fields. Aim of this study was to evaluate the effectiveness of an integrated model of care (special care units SCU in long-term care facilities) to control behavioral disturbances in dementia and to compare it to the more traditional nursing home model. The study is multinational (Italy, France and Sweden) and is funded by the European Commission (DG V). Thirty-one cases (in SCU) and 35 controls (in traditional nursing homes = NH) were enrolled in 43 long-term facilities and assessed 7-14 days after admission and 3 months afterwards. On admission, cases and controls had similar sociodemografic status, cognition, diagnoses, somatic health, and psychotropic drug use, but the former tended to have more severe behavioral disturbances and to be less restrained (19 versus 46%) over the first week after admission. On 3-month follow-up, behavioral disturbances had improved in cases and controls, but with a different pattern: delusions, hallucinations, and agitation improved in the former, and anxiety, euphoria/elation, and irritability/lability in the latter. Sleep disturbances improved in both groups and depression improved in cases and worsened in the controls. Psychotropic drug prescription had not significantly changed in either group. However, notwithstanding the higher frequency of physical restraint use in the controls soon after admission, on 3-month follow-up this was even greater (69%), while it remained low (26%) in the cases. The data suggest that special care unit care of behavioral disturbances in the demented can succesfully control symptoms without additional psychotropic drug and restraint use.