A longitudinal study is proposed, comparing care for persons with Alzheimer's disease in four settings: usual in-patient nursing home care, an Alzheimer's disease inpatient nursing home unit, usual day-care and an Alzheimer's disease day-care unit. The study will investigate physical function, cognitive function behavioral abnormalities, use of physical restraints, medication use and utilization of acute hospital care. The major hypotheses are: (1) Physical function, especially of the lower extremities will, other factors being comparable, decline less among clients of the specialized Alzheimer's disease day care and inpatient programs, than among clients of the usual care day care and inpatient units, respectively. (2) Cognitive function among Alzheimer's disease patients will decline at similar rates in the four settings. (3) Negative behavioral manifestations, use of physical restraining devices and use of psychoactive medications will each be lower among clients of the specialized Alzheimer's disease day care and inpatient programs, than among clients of the usual care day care and inpatient units, respectively. (4) Acute care hospitalization will be less frequent among clients of the specialized Alzheimer's disease day care-and inpatient programs, than among clients of the usual care day care and inpatient units, respectively. The study will use standardized structured measurement techniques to as great an extent as possible. Data collection personnel will be blinded to other data elements. Sample size will be adequate for the issues of interest, analyses will be of longitudinal, not cross-sectional data and statistical techniques appropriate to these data will be used. These methodological features will enhance the validity of study results.
