Proposed is a three year prospective study to test the impact that nursing home placement in special care units (SCUs) has on Alzheimer's disease (AD) patients and their families during the initial adjustment period. The principal objective is to determine whether placement in SCUs produces more desirable outcomes than standard care. Equal numbers of newly admitted male and female Ad patients will be selected from comparable SCUs and traditional nursing facilities (NHs). SCUs will be identified from the 1990 national survey of SCUs and programs (Leon, 1991). Standardized criteria will be used to ensure the selection of comparable SCUs. The comparison group will be selected AD patients from JCAHO accredited long- term care facilities without special care programs or units. Standardized patient selection criteria will be used across all facilities. Patients will be limited to those admitted from home who have an identified caregiver. Outcomes of AD patients and a significant family member will be examined after the sixth month of placement. Patient outcome measures will include: length of survival, measures of physical health status, frequency of hospitalizations, catastrophic reactions, level of agitation, level of cognitive functioning, the number of falls and injuries sustained, frequency and duration in the use of physical restraints and psychotropic drugs, number of incident reports noted in the medical record, and level of participation in facility activities. Outcome measures for families include satisfaction with care provided to their relatives, caregiver stress, and continued involvement with their institutionalized relatives in terms of visitation and care planning. Patient outcome measures will be abstracted from the patient's facility records including information from the minimum data set (MDS). Information from family members will be obtained through telephone interviews at time of placement and at 6 months. Pertinent aspects of the medical record will also be utilized. The overall value of providing care in SCUs will be compared to good quality standard nursing home care through analysis of the collected data. Findings will prove useful in determining whether policies are needed to encourage or discourage continued development of SCUs; in providing directions for regulatory controls; in formulating service guidelines for health care practitioners and families regarding appropriate institutional placement of AD patients; and in eliciting information associated with planning decisions made by nursing home administrators.
| Doraiswamy, P Murali; Leon, Joel; Cummings, Jeffrey L et al. (2002) Prevalence and impact of medical comorbidity in Alzheimer's disease. J Gerontol A Biol Sci Med Sci 57:M173-7 |
| Leon, J; Moyer, D (1999) Potential cost savings in residential care for Alzheimer's disease patients. Gerontologist 39:440-9 |
| Leon, J; Cheng, C K; Neumann, P J (1998) Alzheimer's disease care: costs and potential savings. Health Aff (Millwood) 17:206-16 |
| Leon, J (1994) The 1990/1991 National Survey of Special Care Units in Nursing Homes. Alzheimer Dis Assoc Disord 8 Suppl 1:S72-86 |
