Is Dementia Special Care Really Special? A New Look at an Old Question

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.

https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1532-5415.2007.01559.x