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The Resource Comparison of characteristics of nursing homes and other residential long-term care settings for people with dementia, prepared for Agency for Healthcare Research and Quality ; prepared by RTI International-University of North Carolina Evidence-based Practice Center ; investigators Sheryl Zimmerman [and others], (electronic resource)

Comparison of characteristics of nursing homes and other residential long-term care settings for people with dementia, prepared for Agency for Healthcare Research and Quality ; prepared by RTI International-University of North Carolina Evidence-based Practice Center ; investigators Sheryl Zimmerman [and others], (electronic resource)

Contributor
Summary
OBJECTIVES: To compare characteristics and related outcomes of nursing homes (NHs) and other residential long-term care settings for people with dementia so as to reduce uncertainty when choosing a setting of care for someone with dementia. DATA SOURCES: We searched MEDLINE(r), Embase(r), the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL(r)), AgeLine(r), and PsycINFO(r) from 1990 through March 23, 2012. We identified additional studies from reference lists and experts. REVIEW METHODS: Two people independently selected, abstracted data from, and rated the quality of relevant studies. Given that quantitative analyses were inappropriate because of clinical heterogeneity, insufficient numbers of similar studies, or insufficient or variation in outcome reporting, we synthesized the data qualitatively. Two reviewers graded the strength of evidence (SOE) using established criteria. RESULTS: We identified 14 studies meeting our inclusion criteria. Generally, studies examined characteristics, structures, and process of care for populations with mild to severe dementia. Ten studies addressed health outcomes (Key Question [KQ] 1), and 10 examined psychosocial outcomes (KQ 2) for people with dementia. No eligible studies examined health or psychosocial outcomes for informal caregivers (KQ 3 and KQ 4, respectively). The studies included four prospective cohort studies, nine randomized controlled trials (RCTs), and one non-RCT. Two studies showed that the use of pleasant sensory stimulation reduces agitation. We found limited evidence on a number of interventions, including protocols for individualized care to reduce pain/discomfort and agitation/aggression and functional skill training to improve function. We found largely no differences across outcomes including function, cognition, depressive symptoms, pain, morbidity, behavioral symptoms, engagement, and quality of life based on residence in an NH or residential care/assisted living (RC/AL), other than increased hospitalization for people with mild dementia in RC/AL compared with NHs and increased restraint use in NHs compared with RC/AL for imminently dying residents. CONCLUSIONS: Overall, we found low or insufficient SOE regarding the effect of organizational characteristics, structures, and processes of care on health and psychosocial outcomes for people with dementia and no evidence for informal caregivers. Findings of moderate SOE indicate that pleasant sensory stimulation reduces agitation. Also, although the SOE is low, protocols for individualized care and to improve function result in better outcomes. Finally, outcomes do not differ between NHs and RC/AL except when medical care is indicated. Additional research is needed to develop a sufficient evidence base to support decisionmaking
Language
eng
Work
Publication
Extent
1 online resource (190 pages)
Note
"October 2012."
Instance
Label
Comparison of characteristics of nursing homes and other residential long-term care settings for people with dementia
Title
Comparison of characteristics of nursing homes and other residential long-term care settings for people with dementia
Statement of responsibility
prepared for Agency for Healthcare Research and Quality ; prepared by RTI International-University of North Carolina Evidence-based Practice Center ; investigators Sheryl Zimmerman [and others]
Title variation
Effective health care program
Contributor
Subject
Genre
Language
eng
Summary
OBJECTIVES: To compare characteristics and related outcomes of nursing homes (NHs) and other residential long-term care settings for people with dementia so as to reduce uncertainty when choosing a setting of care for someone with dementia. DATA SOURCES: We searched MEDLINE(r), Embase(r), the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL(r)), AgeLine(r), and PsycINFO(r) from 1990 through March 23, 2012. We identified additional studies from reference lists and experts. REVIEW METHODS: Two people independently selected, abstracted data from, and rated the quality of relevant studies. Given that quantitative analyses were inappropriate because of clinical heterogeneity, insufficient numbers of similar studies, or insufficient or variation in outcome reporting, we synthesized the data qualitatively. Two reviewers graded the strength of evidence (SOE) using established criteria. RESULTS: We identified 14 studies meeting our inclusion criteria. Generally, studies examined characteristics, structures, and process of care for populations with mild to severe dementia. Ten studies addressed health outcomes (Key Question [KQ] 1), and 10 examined psychosocial outcomes (KQ 2) for people with dementia. No eligible studies examined health or psychosocial outcomes for informal caregivers (KQ 3 and KQ 4, respectively). The studies included four prospective cohort studies, nine randomized controlled trials (RCTs), and one non-RCT. Two studies showed that the use of pleasant sensory stimulation reduces agitation. We found limited evidence on a number of interventions, including protocols for individualized care to reduce pain/discomfort and agitation/aggression and functional skill training to improve function. We found largely no differences across outcomes including function, cognition, depressive symptoms, pain, morbidity, behavioral symptoms, engagement, and quality of life based on residence in an NH or residential care/assisted living (RC/AL), other than increased hospitalization for people with mild dementia in RC/AL compared with NHs and increased restraint use in NHs compared with RC/AL for imminently dying residents. CONCLUSIONS: Overall, we found low or insufficient SOE regarding the effect of organizational characteristics, structures, and processes of care on health and psychosocial outcomes for people with dementia and no evidence for informal caregivers. Findings of moderate SOE indicate that pleasant sensory stimulation reduces agitation. Also, although the SOE is low, protocols for individualized care and to improve function result in better outcomes. Finally, outcomes do not differ between NHs and RC/AL except when medical care is indicated. Additional research is needed to develop a sufficient evidence base to support decisionmaking
Member of
Cataloging source
ERL
Funding information
Conducted by the RTI International-University of North Carolina Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (AHRQ)
Government publication
federal national government publication
Illustrations
illustrations
Index
no index present
Literary form
non fiction
Nature of contents
  • dictionaries
  • bibliography
NLM call number
WT 27.AA1
http://library.link/vocab/relatedWorkOrContributorDate
1957-
http://library.link/vocab/relatedWorkOrContributorName
  • Zimmerman, Sheryl
  • RTI International-University of North Carolina Evidence-based Practice Center
  • United States
  • Effective Health Care Program (U.S.)
Series statement
  • Comparative effectiveness review
  • AHRQ publication,
Series volume
  • no.79
  • no. 12(13)-EHC127-EF
http://library.link/vocab/subjectName
  • Dementia
  • Assisted Living Facilities
  • Comparative Effectiveness Research
  • Nursing Homes
  • Outcome Assessment, Health Care
  • Quality of Life
  • United States
  • United States
http://bibfra.me/vocab/relation/supportingbody
RzTDSdffmEM
Label
Comparison of characteristics of nursing homes and other residential long-term care settings for people with dementia, prepared for Agency for Healthcare Research and Quality ; prepared by RTI International-University of North Carolina Evidence-based Practice Center ; investigators Sheryl Zimmerman [and others], (electronic resource)
Instantiates
Publication
Note
"October 2012."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
  • cr
Carrier MARC source
rdacarrier
Content category
text
Content type code
  • txt
Content type MARC source
rdacontent
Control code
824190014
Extent
1 online resource (190 pages)
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
  • c
Other physical details
illustrations
Specific material designation
remote
System control number
(OCoLC)824190014
Label
Comparison of characteristics of nursing homes and other residential long-term care settings for people with dementia, prepared for Agency for Healthcare Research and Quality ; prepared by RTI International-University of North Carolina Evidence-based Practice Center ; investigators Sheryl Zimmerman [and others], (electronic resource)
Publication
Note
"October 2012."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
  • cr
Carrier MARC source
rdacarrier
Content category
text
Content type code
  • txt
Content type MARC source
rdacontent
Control code
824190014
Extent
1 online resource (190 pages)
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
  • c
Other physical details
illustrations
Specific material designation
remote
System control number
(OCoLC)824190014

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