The effects of group living homes on older people with dementia: a comparison with traditional nursing home care

Program on Aging, Netherlands Institute of Mental Health and Addiction, 3500 AS Utrecht, The Netherlands.
International Journal of Geriatric Psychiatry (Impact Factor: 2.87). 09/2009; 24(9):970-8. DOI: 10.1002/gps.2205
Source: PubMed


The aim of this study was to investigate the effects of group living homes on quality of life and functioning of people with dementia.
The study had a quasi-experimental design with a baseline measurement on admission and an effect measurement six months later. Participants were 67 residents in 19 group living homes and 97 residents in seven traditional nursing homes. DQOL and QUALIDEM measured quality of life, functional status was examined with MMSE, IDDD, RMBPC, NPI-Q and RISE from RAI. Use of psychotropic drugs and physical restraints was also assessed. Linear and logistic regression analyses analyzed the data.
After adjustment for differences in baseline characteristics, residents of group living homes needed less help with ADL and were more socially engaged. There were no differences in behavioral problems or cognitive status. Also after adjusting, two of the 12 quality of life subscales differed between the groups. Residents of group living homes had more sense of aesthetics and had more to do. While there were no differences in prescription of psychotropic drugs, residents of group living homes had less physical restraints.
Group living homes had some beneficial effects on its residents, but traditional nursing homes performed well as well. Possible study limitations included the baseline differences between the study groups and the use of different informants on T0 and T1. Future nursing home care may very well be a combination of the best group living care and traditional nursing home care have to offer.

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    • "Despite these developments, little evidence is available on the effects of small-scale environments on residents. Some promising results have been reported, for example, related to residents' functional status (te Boekhorst et al., 2009). Effects on quality of life are contradictory, with some studies reporting positive effects on specific domains (Kane et al., 2007), while others find no effects on overall quality of life (Verbeek et al., 2010; de Rooij et al., 2012b). "
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    ABSTRACT: Background: Small-scale, home-like care environments are increasingly implemented in institutional nursing care as a model to promote resident-directed care, although evidence on its effects is sparse. This study focuses on the effects of small-scale living facilities on the behavior of residents with dementia and use of physical restraints and psychotropic drugs. Methods: A quasi-experimental study was conducted comparing residents in two types of long-term institutional nursing care (i.e., small-scale living facilities and traditional psychogeriatric wards) on three time points: at baseline and follow-ups after six and 12 months. Residents were matched at baseline on cognitive and functional status to increase comparability of groups at baseline. Nurses assessed neuropsychiatric and depressive symptoms, agitation, social engagement, and use of physical restraints using questionnaires. Psychotropic drug use was derived from residents' medical records. Results: In total, 259 residents were included: 124 in small-scale living facilities and 135 controls. Significantly fewer physical restraints and psychotropic drugs were used in small-scale living facilities compared with traditional wards. Residents in small-scale living facilities were significantly more socially engaged, at baseline and after six months follow-up, and displayed more physically non-aggressive behavior after 12 months than residents in traditional wards. No other differences were found. Conclusions: This study suggests positive effects of small-scale living facilities on the use of physical restraints and psychotropic drugs. However, the results for behavior were mixed. More research is needed to gain an insight on the relationship between dementia care environment and other residents' outcomes.
    International Psychogeriatrics 01/2014; 26:657-668. DOI:10.1017/S1041610213002512 · 1.93 Impact Factor
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    • "Elsewhere, there are few studies which have directly compared QoL in dementia by home versus institutional care. The findings from these studies are mixed with some studies reporting that the place of residence plays considerable part in QoL (Missotten et al., 2009; te Boekhorst et al., 2009), whereas other studies have reported no significant difference in QoL between people with dementia in institutional care (te Boekhorst et al., 2009). Precisely why we should have observed such large differences whereas other studies did not is not entirely clear, given that on all (but one) of the health status measures there was no statistically significant difference between the two study cohorts. "
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    ABSTRACT: Background: Living arrangements play an important role in determining the quality of life (QoL) of people with dementia. Although informal care (home-based) is favored, the transition to formal (institutional) care often becomes necessary, especially in the later stages of dementia. Nevertheless, there is currently no definitive evidence showing that informal or formal care provides a higher QoL for those with dementia.Objective: To compare the QoL of people with dementia in the nursing home and home care, and identify factors that differentiate their QoL.Design and methods: This was a cross-sectional survey. A total of 49 people with dementia ≥60 years old were recruited from government nursing homes and hospitals (home care). Consenting participants were assessed on cognitive severity, QoL, activities of daily living (ADLs), depression, and social isolation/connectedness by the Short Mini Mental State Examination (SMMSE), the WHO-8 (the EUROHIS-QOL), Short Assessment of Quality of Life (AQoL-8), Barthel Index (BI), Cornell Scale for Depression (CSDD), and Friendship Scale (FS).Results: There were significant differences in QoL, HRQoLs, ADLs, and social connectedness among people with dementia in home care (n = 19) and those in nursing homes (n = 30) (p < 0.01). No significant differences were found by socio-demographic factors, cognitive severity, or depression between the study cohorts.Conclusions: Older adults with dementia who were living at home experienced higher QoL, ADLs, and social connectedness compared with those living in institutional care. Support should be provided enabling home care and empowering caregivers to provide better care for people with dementia.
    Dementia 07/2013; 14(1). DOI:10.1177/1471301213494509 · 0.91 Impact Factor
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    • "The focus of research in this field has mainly been on a comparison of quality of life of residents and staff wellbeing in two or three types of arrangements [8-17]. Two studies focusing on the effect of small scale facilities in the Netherlands compared to large scale nursing homes show modest positive results of small scale facilities on some aspects of quality of life of residents with dementia, but no differences are found for overall quality of life [10,18]. Furthermore, these previous studies show that staff working in group living homes experience more job satisfaction, a higher motivation and less burnout than staff working in regular nursing homes [9,18]. "
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    ABSTRACT: There is limited information available on how characteristics of the organization of nursing home care and especially group living home care and staff ratio contribute to care staff well being, quality of care and residents' quality of life. Furthermore, it is unknown what the consequences of the increasingly small scale organization of care are for the amount of care staff required in 2030 when there will be much more older people with dementia. This manuscript describes the design of the 'Living Arrangements for people with Dementia study' (LAD-study). The aim of this study is to include living arrangements from every part of this spectrum, ranging from large scale nursing homes to small group living homes. The LAD-study exists of quantitative and qualitative research. Primary outcomes of the quantitative study are wellbeing of care staff, quality of care and quality of life of residents. Furthermore, data concerning staff ratio and characteristics of the living arrangements such as group living home care characteristics are assessed. To get more in-depth insight into the barriers and facilitators in living arrangements for people with dementia to provide good care, focus groups and Dementia Care Mapping are carried out. Results of this study are important for policymakers, directors and staff of living arrangements providing nursing home care to people with dementia and essential for the development of methods to improve quality of care, residents' and staff well-being. Data collection will be repeated every two years, to generate knowledge on the results of changing policies in this field.
    BMC Geriatrics 03/2011; 11(1):11. DOI:10.1186/1471-2318-11-11 · 1.68 Impact Factor
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