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Is Dementia Special Care Really Special? A New Look at an Old Question
Author(s) -
Gruneir Andrea,
Lapane Kate L.,
Miller Susan C.,
Mor Vincent
Publication year - 2008
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2007.01559.x
Subject(s) - medicine , toileting , dementia , odds ratio , confidence interval , antipsychotic , urinary incontinence , minimum data set , nursing homes , activities of daily living , gerontology , emergency medicine , physical therapy , disease , psychiatry , surgery , nursing , schizophrenia (object oriented programming)
OBJECTIVES: To quantify differences in care provided to nursing home (NH) residents with dementia living on and off dementia special care units (SCUs). DESIGN: Cross‐sectional study using propensity score adjustment for resident and NH characteristics. SETTING: Free‐standing NHs in nonrural U.S. counties that had an SCU in 2004 (N=1,896). PARTICIPANTS: Long‐stay (≥90 days) NH residents with a diagnosis of Alzheimer's disease or dementia and at least moderate cognitive impairment (N=69,131). MEASUREMENTS: Resident‐level NH care processes such as physical restraints, bed rails, feeding tubes, psychotropic medications, and incontinence care. RESULTS: There was no difference in the use of physical restraints (adjusted odds ratio (AOR)=0.94, 95% confidence interval (CI)=0.79–1.11), but SCU residents were less likely to have had bed rails (AOR=0.55, 95% CI=0.46–0.64) and to have been tube fed (AOR=0.36, 95% CI=0.30–0.43). SCU residents were more likely to be on toileting plans (AOR=1.23, 95% CI=1.08–1.39) and less likely to use pads or briefs in the absence of a toileting plan (AOR=0.73, 95% CI=0.61–0.88). SCU residents were more likely to have received psychotropic medications (AOR=1.23, 95% CI=1.05–1.44), primarily antipsychotics (SCU=44.9% vs non‐SCU=30.0%). CONCLUSION: SCU residents received different care than comparable non‐SCU residents. Most strikingly, SCU residents had greater use of antipsychotic medications.