An estimated 65% of new nursing home admissions suffer from dementia, and concern for the quality of their care is growing. In response, the use of special care units (SCUs) for persons with dementia is proliferating. The growth of SCUs has been controversial, because it has proceeded in an unregulated fashion and without clear benefit for residents. Health care professionals recognize the need to examine the particular features of long-term care which are important in the care of nursing home residents with dementia. Given the limited research in this area, the proposed study is designed to: (l) describe and compare the characteristics of a diverse set of 59 nursing homes (including 14 SCUs) which contain a mix of patients similar to those in U.S. facilities; and (2) assess the relationship between facility characteristics (e.g. staff/resident ratio; resident involvement in activities) and health outcomes (mortality, morbidity, health care use) for demented residents during the year following admission to the nursing home. Secondarily, it will examine whether the effect of facility characteristics influence functional outcomes (cognition; independence in activities of daily living; behavior) for survivors at one year post- admission, and whether the facility characteristics which are beneficial for demented residents are also of benefit for non-demented residents. This study will build on and use data from a current study of new admissions to Maryland nursing homes (ROl AG082II). All individuals (N=2000) aged 65 or older admitted for the first time to a 24% stratified random sample of 53 nursing homes during one year are being enrolled. Within one month of admission, evaluators interview residents, family and staff and abstract charts to obtain information about medical, cognitive and functional status. An expert panel of neurologists and psychiatrists is examining these data and making a determination of dementia following DSM-III-R criteria. Mortality, morbidity (infections, pressure sores, falls, febrile episodes) and nursing home and acute care use are being monitored through one year by chart review. The proposed project will use data collected in the current study and will add 6 SCUs (and 60 new admissions) to the 53 facilities. Detailed information about the facility (the treatment setting and the type of care provided) will be obtained from direct observation, interview with administrative personnel, and review of care plans. Also, information on functioning will be obtained for those surviving to one year. This study is unique in its examination of the relationship of facility characteristics to multiple quality of life outcomes for a large cohort of residents who are representative of all U.S. admissions and whose diagnosis of dementia is determined by an expert panel.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
First Independent Research Support & Transition (FIRST) Awards (R29)
Project #
5R29AG011407-03
Application #
2052600
Study Section
Epidemiology and Disease Control Subcommittee 2 (EDC)
Project Start
1993-09-30
Project End
1997-02-28
Budget Start
1995-09-01
Budget End
1996-08-31
Support Year
3
Fiscal Year
1995
Total Cost
Indirect Cost
Name
University of Maryland Baltimore
Department
Public Health & Prev Medicine
Type
Schools of Medicine
DUNS #
003255213
City
Baltimore
State
MD
Country
United States
Zip Code
21201
Rich, Shayna E; Gruber-Baldini, Ann L; Quinn, Charlene C et al. (2009) Discussion as a factor in racial disparity in advance directive completion at nursing home admission. J Am Geriatr Soc 57:146-52
Quinn, Charlene C; Gruber-Baldini, Ann L; Port, Cynthia L et al. (2009) The role of nursing home admission and dementia status on care for diabetes mellitus. J Am Geriatr Soc 57:1628-33
Boockvar, Kenneth S; Gruber-Baldini, Ann L; Stuart, Bruce et al. (2008) Medicare expenditures for nursing home residents triaged to nursing home or hospital for acute infection. J Am Geriatr Soc 56:1206-12
Kaup, Bruce A; Loreck, David; Gruber-Baldini, Ann L et al. (2007) Depression and its relationship to function and medical status, by dementia status, in nursing home admissions. Am J Geriatr Psychiatry 15:438-42
Bercovitz, Anita; Gruber-Baldini, Ann L; Burton, Lynda C et al. (2005) Healthcare utilization of nursing home residents: comparison between decedents and survivors. J Am Geriatr Soc 53:2069-75
Hill-Westmoreland, Elizabeth E; Gruber-Baldini, Ann L (2005) Falls documentation in nursing homes: agreement between the minimum data set and chart abstractions of medical and nursing documentation. J Am Geriatr Soc 53:268-73
Stuart, Bruce; Gruber-Baldini, Ann L; Fahlman, Cheryl et al. (2005) Medicare cost differences between nursing home patients admitted with and without dementia. Gerontologist 45:505-15
Zuckerman, Ilene H; Hernandez, Jose Josue; Gruber-Baldini, Ann L et al. (2005) Potentially inappropriate prescribing before and after nursing home admission among patients with and without dementia. Am J Geriatr Pharmacother 3:246-54
Boockvar, Kenneth S; Gruber-Baldini, Ann L; Burton, Lynda et al. (2005) Outcomes of infection in nursing home residents with and without early hospital transfer. J Am Geriatr Soc 53:590-6
Magaziner, Jay; Zimmerman, Sheryl; Gruber-Baldini, Ann L et al. (2005) Mortality and adverse health events in newly admitted nursing home residents with and without dementia. J Am Geriatr Soc 53:1858-66

Showing the most recent 10 out of 18 publications