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Effects of small-scale, home-like facilities in dementia care on residents’ behavior, and use of physical restraints and psychotropic drugs: a quasi-experimental study

Published online by Cambridge University Press:  10 January 2014

Hilde Verbeek ,
Sandra M.G. Zwakhalen ,
Erik van Rossum ,
Ton Ambergen ,
Gertrudis I.J.M. Kempen  and
Jan P.H. Hamers
Hilde Verbeek*
Affiliation:
Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
Sandra M.G. Zwakhalen
Affiliation:
Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
Erik van Rossum
Affiliation:
Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands Centre of Research on Autonomy and Participation, Zuyd University of Applied Sciences, Heerlen, the Netherlands
Ton Ambergen
Affiliation:
Department of Methodology and Statistics, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
Gertrudis I.J.M. Kempen
Affiliation:
Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
Jan P.H. Hamers
Affiliation:
Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
*
Correspondence should be addressed to: Dr. Hilde Verbeek, Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands. Phone: +31-43-3881513; Fax +31-43-3884162. Email: h.verbeek@maastrichtuniversity.nl.
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Abstract

Background:

Small-scale, home-like care environments are increasingly implemented in institutional nursing care as a model to promote resident-directed care, although evidence on its effects is sparse. This study focuses on the effects of small-scale living facilities on the behavior of residents with dementia and use of physical restraints and psychotropic drugs.

Methods:

A quasi-experimental study was conducted comparing residents in two types of long-term institutional nursing care (i.e. small-scale living facilities and traditional psychogeriatric wards) on three time points: at baseline and follow-ups after six and 12 months. Residents were matched at baseline on cognitive and functional status to increase comparability of groups at baseline. Nurses assessed neuropsychiatric and depressive symptoms, agitation, social engagement, and use of physical restraints using questionnaires. Psychotropic drug use was derived from residents’ medical records.

Results:

In total, 259 residents were included: 124 in small-scale living facilities and 135 controls. Significantly fewer physical restraints and psychotropic drugs were used in small-scale living facilities compared with traditional wards. Residents in small-scale living facilities were significantly more socially engaged, at baseline and after six months follow-up, and displayed more physically non-aggressive behavior after 12 months than residents in traditional wards. No other differences were found.

Conclusions:

This study suggests positive effects of small-scale living facilities on the use of physical restraints and psychotropic drugs. However, the results for behavior were mixed. More research is needed to gain an insight on the relationship between dementia care environment and other residents’ outcomes.

Keywords

dementianursing homegroup livinglong-term careengagement
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 4 , April 2014 , pp. 657 - 668
Copyright
Copyright © International Psychogeriatric Association 2014 

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