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Effects of small-scale, home-like facilities in dementia care on residents’ behavior, and use of physical restraints and psychotropic drugs: a quasi-experimental study

Published online by Cambridge University Press:  10 January 2014

Hilde Verbeek ,
Sandra M.G. Zwakhalen ,
Erik van Rossum ,
Ton Ambergen ,
Gertrudis I.J.M. Kempen  and
Jan P.H. Hamers
Hilde Verbeek*
Affiliation:
Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
Sandra M.G. Zwakhalen
Affiliation:
Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
Erik van Rossum
Affiliation:
Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands Centre of Research on Autonomy and Participation, Zuyd University of Applied Sciences, Heerlen, the Netherlands
Ton Ambergen
Affiliation:
Department of Methodology and Statistics, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
Gertrudis I.J.M. Kempen
Affiliation:
Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
Jan P.H. Hamers
Affiliation:
Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
*
Correspondence should be addressed to: Dr. Hilde Verbeek, Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands. Phone: +31-43-3881513; Fax +31-43-3884162. Email: h.verbeek@maastrichtuniversity.nl.
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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.

Keywords

dementianursing homegroup livinglong-term careengagement
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 4 , April 2014 , pp. 657 - 668
Copyright
Copyright © International Psychogeriatric Association 2014 

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References

Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988). Cornell Scale for Depression in Dementia. Biological Psychiatry, 23, 271–284.Google Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, revised. Washington, DC: American Psychiatric Association.Google Scholar
Cohen-Mansfield, J., Marx, M. S., Dakheel-Ali, M., Regier, N. G. and Thein, K. (2010). Can persons with dementia be engaged with stimuli? American Journal of Geriatric Psychiatry, 18, 351–362.Google Scholar
Day, K., Carreon, D. and Stump, C. (2000). The therapeutic design of environments for people with dementia: a review of the empirical research. Gerontologist, 40, 397–416.Google Scholar
de Rooij, A. H., Luijkx, K. G., Declercq, A. G., Emmerink, P. M. and Schols, J. M. (2012a). Professional caregivers’ mental health problems and burnout in small-scale and traditional long term care settings for elderly people with dementia in the Netherlands and Belgium. Journal of the American Medical Directors Association, 13, 486.e7–11.Google Scholar
de Rooij, A. H., Luijkx, K. G., Schaafsma, J., Declercq, A. G., Emmerink, P. M. and Schols, J. M. (2012b). Quality of life of residents with dementia in traditional versus small-scale long-term care settings: a quasi-experimental study. International Journal of Nursing Studies, 49, 931–940.CrossRefGoogle ScholarPubMed
Ferri, C. P. et al. (2005). Global prevalence of dementia: a Delphi consensus study. Lancet, 366, 2112–2117.Google Scholar
Folstein, M. F., Folstein, S. E. and Mchugh, P. R. (1975). A practical method for grading the cognitive status of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Guthrie, B., Clark, S. A. and McCowan, C. (2010). The burden of psychotropic drug prescribing in people with dementia: a population database study. Age and Ageing, 39, 637–642.CrossRefGoogle Scholar
Hamers, J. P. and Huizing, A. R. (2005). Why do we use physical restraints in the elderly? Zeitschrift für Gerontologie und Geriatrie, 38, 19–25.Google Scholar
Huizing, A. R., Hamers, J. P., Gulpers, M. J. and Berger, M. P. (2009). A cluster-randomized trial of an educational intervention to reduce the use of physical restraints with psychogeriatric nursing home residents. Journal of the American Geriatrics Society, 57, 1139–1148.Google Scholar
Kane, R. A., Lum, T. Y., Cutler, L. J., Degenholtz, H. B. and Yu, T.-C. (2007). Resident outcomes in small-house nursing homes: a longitudinal evaluation of the initial Green House program. Journal of the American Geriatric Society, 55, 832–839.Google Scholar
Karlsson, S., Bucht, G., Eriksson, S. and Sandman, P. O. (2001). Factors relating to the use of physical restraints in geriatric care settings. Journal of the American Geriatric Society, 49, 1722–1728.Google Scholar
Kat, M. G., De Jonghe, J. F. M., Aalten, P., Kalisvaart, C. J., Dröes, R. M. and Verhey, F. R. J. (2002). Neuropsychiatric symptoms of dementia: psychometric aspects of the Neuropsychiatric Inventory (NPI) Dutch version. Tijdschrift voor Gerontologie en Geriatrie, 33, 150–155.Google Scholar
Mohler, R., Richter, T., Kopke, S. and Meyer, G. (2011). Interventions for preventing and reducing the use of physical restraints in long-term geriatric care. Cochrane Database of Systematic Reviews, CD007546.Google Scholar
Mor, V. et al. (1995). The structure of social engagement among nursing home residents. Journals of Gerontology, B: Psychological Sciences and Social Sciences, 50, P1–8.Google Scholar
Morris, J. N. et al. (1994). MDS Cognitive Performance Scale. Journal of Gerontology: Medical Sciences, 49, M174–182.CrossRefGoogle ScholarPubMed
Morris, J. N., Fries, B. E. and Morris, S. A. (1999). Scaling ADLs within the MDS. Journals of Gerontology, A: Biological Sciences and Medical Sciences, 54, M546–553.Google Scholar
Onishi, J. et al. (2006). Behavioral, psychological and physical symptoms in group homes for older adults with dementia. International Psychogeriatrics, 18, 75–86.Google Scholar
Reisberg, B., Ferris, S. H., de Leon, M. J. and Crook, T. (1982). The Global Deterioration Scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 1136–1139.Google Scholar
Rochon, P. A. et al. (2007). Variation in nursing home antipsychotic prescribing rates. Archives of Internal Medicine, 167, 676–683.Google Scholar
Scherder, E. J., Bogen, T., Eggermont, L. H., Hamers, J. P. and Swaab, D. F. (2010). The more physical inactivity, the more agitation in dementia. International Psychogeriatrics, 22, 1203–1208.CrossRefGoogle ScholarPubMed
Smit, D., de Lange, J., Willemse, B. and Pot, A. M. (2012). The relationship between small-scale care and activity involvement of residents with dementia. International Psychogeriatrics, 24, 722–732.Google Scholar
Svarstad, B. L., Mount, J. K. and Bigelow, W. (2001). Variations in the treatment culture of nursing homes and responses to regulations to reduce drug use. Psychiatric Services, 52, 666–672.CrossRefGoogle ScholarPubMed
te Boekhorst, S., Depla, M. F., de Lange, J., Pot, A. M. and Eefsting, J. A. (2009). The effects of group living homes on older people with dementia: a comparison with traditional nursing home care. International Journal of Geriatric Psychiatry, 24, 970–978.Google Scholar
te Boekhorst, S., Pot, A. M., Depla, M., Smit, D., de Lange, J. and Eefsting, J. (2008a). Group living homes for older people with dementia: the effects on psychological distress of informal caregivers. Aging and Mental Health, 12, 761–768.Google Scholar
te Boekhorst, S., Willemse, B., Depla, M. F., Eefsting, J. A. and Pot, A. M. (2008b). Working in group living homes for older people with dementia: the effects on job satisfaction and burnout and the role of job characteristics. International Psychogeriatrics, 20, 927–940.Google Scholar
te Boekhorst, S., Depla, M. F., Pot, A. M., de Lange, J. and Eefsting, J. A. (2011). The ideals of group living homes for people with dementia: do they practice what they preach? International Psychogeriatrics, 23, 1526–1527.Google Scholar
Verbeek, H., van Rossum, E., Zwakhalen, S. M., Ambergen, T., Kempen, G. I. and Hamers, J. P. (2009a). The effects of small-scale, homelike facilities for older people with dementia on residents, family caregivers and staff: design of a longitudinal, quasi-experimental study. BMC Geriatrics, 9, 3.Google Scholar
Verbeek, H., van Rossum, E., Zwakhalen, S. M., Kempen, G. I. and Hamers, J. P. (2009b). Small, homelike care environments for older people with dementia: a literature review. International Psychogeriatrics, 21, 252–264.Google Scholar
Verbeek, H., Zwakhalen, S. M., van Rossum, E., Ambergen, T., Kempen, G. I. and Hamers, J. P. (2010). Dementia care redesigned: effects of small-scale living facilities on residents, their family caregivers, and staff. Journal of the American Medical Directors Association, 11, 662–670.Google Scholar
Verbeek, H., Zwakhalen, S. M., van Rossum, E., Kempen, G. I. and Hamers, J. P. (2012). Small-scale, homelike facilities in dementia care: a process evaluation into the experiences of family caregivers and nursing staff. International Journal of Nursing Studies, 49, 21–29.Google Scholar
White-Chu, E. F., Graves, W. J., Godfrey, S. M., Bonner, A. and Sloane, P. (2009). Beyond the medical model: the culture change revolution in long-term care. Journal of the American Medical Directors Association, 10, 370–378.Google Scholar
Zuidema, S. U., de Jonghe, J. F., Verhey, F. R. and Koopmans, R. T. (2007). Agitation in Dutch institutionalized patients with dementia: factor analysis of the Dutch version of the Cohen-Mansfield Agitation Inventory. Dementia Geriatric Cognitive Disorders, 23, 35–41.Google Scholar