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The Quality of Advanced Dementia Care in the Nursing Home: The Role of Special Care Units

Cadigan, Rebecca Orfaly MSc*; Grabowski, David C. PhD*; Givens, Jane L. MD, MSCE*,†,‡; Mitchell, Susan L. MD, MPH*,†,‡

doi: 10.1097/MLR.0b013e31825dd713
Original Articles

Background: The quality of nursing home care for residents with advanced dementia has been described as suboptimal. One relatively understudied factor is the impact of special care units (SCUs) for dementia for residents at the end stage of this disease.

Objective: To examine the association between residence in an SCU and the quality of end-of-life care for nursing home residents with advanced dementia.

Research Design: This study used longitudinal data on 323 nursing home residents with advanced dementia living in 22 Boston-area facilities. Using multivariate methods, we analyzed the association between residence in an SCU and measures of quality of end-of-life care including: treatment of pain and dyspnea, prevalence of pressure ulcers, hospitalization, tube feeding, antipsychotic drug use, advance care planning, and health care proxy (HCP) satisfaction with care.

Results: A total of 43.7% residents were cared for in an SCU. After multivariate adjustment, residents in SCUs were more likely to receive treatment for dyspnea, had fewer hospitalizations, were less likely to be tube fed, and more likely to have a do-not-hospitalize order, compared with non-SCU residents. However, non-SCU residents were more likely to be treated for pain, had fewer pressure ulcers, and less frequent use of antipsychotic drugs than SCU residents. HCPs of SCU residents reported greater satisfaction with care than HCPs of non-SCU residents.

Conclusions: Residence in an SCU is associated with some, but not all, markers of better quality end-of-life care among nursing home residents with advanced dementia.

*Harvard Medical School, Boston

Hebrew SeniorLife, Institute for Aging Research

Beth Israel Deaconess Medical Center, Boston, MA

Supported by NIH-NIA R01 AG024091. R.O.C. acknowledges support from an AHRQ predoctoral National Research Service Award. J.L.G. is supported by NIH-NIA K23 AG034967. S.L.M. is supported by NIH-NIA K24 AG033640.

The authors declare no conflict of interest.

Reprints: Rebecca Orfaly Cadigan, MSc, Harvard University, Health Policy Interfaculty Initiative, 14 Story Street, 4th Floor, Cambridge, MA 02138. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.