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Special units in nursing homes for patients with Alzheimer's disease do not appear to result in any functional benefits. Researchers evaluated Alzheimer's disease special care units (SCUs) in more than 800 facilities in four states covering 77,337 Alzheimer's patients. No differences were seen in the ability to perform activities of daily living in patients in SCUs compared to regular units. However, many family members may prefer to have the patient in an SCU., Context.--Alzheimer disease special care units (SCUs) in nursing homes are increasingly prevalent, but little is known about their effects on residents' outcomes. Objective.--To analyze the effect of SCU residence on the rates at which residents decline in functional status. Design.--A cohort of nursing home residents assessed at multiple points during about 1 year. Facility staff completed all assessments using the Minimum Data Set for Nursing Home Resident Assessment and Care Screening (MDS). Setting.--Medicare- or Medical-certified nursing facilities. Patients or Other Participants.--All nursing home residents in 1993 and early 1994 in Kansas, Maine, Mississippi, and South Dakota. Serial MDS assessments of 77 337 residents in more than 800 facilities, including 1228 residents in 48 facilities with SCUs. Main Outcome Measures.--Decline in locomotion, transferring, toileting, eating, dressing, and a summary activities of daily living index; decline in urinary and bowel continence; and significant weight loss. Results.--No statistically significant difference was observed in the speed of decline for residents in SCUs and traditional units in any of the 9 outcomes. Residents were matched on a variety of characteristics, and subgroup analyses were performed. In none did we observe a pattern of better outcomes among SCU residents. Conclusions.--Although SCUs may have provided unmeasured benefits to families and residents, it does not appear that those benefits included any slowing in the rates of functional decline experienced by individuals with dementia. JAMA. 1997 978:1340-1344

Disruptive vocalization (DV) is a common problem in the management of cognitively and physically impaired older people. This article reports the results of a consensus meeting convened to provide guidelines for clinicians and recommendations for researchers in this difficult and little-studied behavioral problem. DV arises largely in people with cognitive impairment and generally reflects an underlying need or discomfort. A variety of factors can precipitate and aggravate DV; the key to management is appropriate identification of all possible factors and development of an individualized treatment plan. Key Words: Disruptive vocalization, Screaming, Behavioral problems, Dementia, Nursing homes

A study of the mind sets of 60 aged with chronic dizziness and 66 healthy subjects revealed direct correlations between psychological factors and the nature of symptom occurrence and responses in aged patients with dizziness. Chronic dizziness in the aged is directly correlated to their fears of falling.

A comparative analysis of the ability of the Minimum Data Set Cognitive Performance Scale and the Mini-Mental State Examination to detect cognitive status of nursing home residents suggests that both these scales provide accurate measures of cognition. The area under the receiver operating characteristics curve provides the extent of diagnostic precision.

Several factors influence research on Special Care Units (SCUs) for Alzheimer's disease patients, such as differing facilities and size of SCUs, duration of patient residence and dementia staging and diagnosis bias. There should be a usage of proper, valid and reliable methods for a detailed study of one subject over a period of time and this would help provide more accurate and unbiased data for these researches.

Progressive dementias, such as Alzheimer's disease, account for approximately 50 percent of nursing home admissions in the US. As the national population ages, the number is increasing. Special care units (SCU) have evolved as one way to meet the needs of these patients. They are specially designed for the cognitively impaired, staff is specially trained, and activities are individualized. The present study was designed to identify factors contributing to the quality of care of demented patients in nursing homes. Sixty-three nursing home units, including both SCUs and non-SCUs, were observed and data was collected on the type and quality of care given, staff and administrative attitudes, overall environment, and the patient population. Ratings were then made and the authors classified the units into one of eight types: ideal, uncultivated, heart of gold, rotten at the core, institutional, limited, conventional, and execrable. The 'ideal' setting had a therapeutic rather than maintenance philosophy of care, an administration knowledgeable in dementia, a staff highly experienced in caring for memory-impaired patients, and an overall concern for staff and patients. Physical maintenance of the unit was important, as was its layout; patients had privacy and rooms were personalized. The first three types of units comprised 22 percent of the 63 units surveyed; 21 percent fell into the execrable, rotten at the core, or conventional categories. No SCUs fell into the two worst categories, and no non-SCUs fell into the two best. It is not clear why this is true, but it is possible that SCUs receive better funding and can therefore provide better overall care, or that differences in admission policies of the two types of units have an effect. The results show that SCUs can provide high-quality care for demented patients and that all SCUs are not equally able to do this. Consumers may use the types of units presented in this article as a general guideline in choosing nursing home care for a demented adult. (Consumer Summary produced by Reliance Medical Information, Inc.)

Nursing home patients who are demented (have severe intellectual impairment) are often restrained, either physically (with special chairs, cuffs, or vests) or pharmacologically (with sedating drugs). However, these practices have come under public criticism because of their negative effects on patient mobility, behavior, and health. Specialized dementia care units, typically established in a wing or separate section of a nursing home, employ staff trained to care for demented patients and often try to minimize the use of restraints. To compare the use of physical and pharmacologic restraints in specialized units and in the traditional nursing home setting, 31 dementia units (housing 307 patients) and 32 traditional nursing home units (318 patients) in five states were studied. Data were collected by questionnaires, review of medical records, rating scales completed by nursing staff, and direct observation. The patients in the specialized units were less functionally impaired than those in the traditional units. In dementia units, 18.1 percent of the patients who were not in bed were physically restrained, compared with 51.6 percent of traditional-care patients. The proportions of patients under pharmacologic restraint were similar in the two types of unit (45 percent and 43 percent, for specialized and traditional units, respectively). The factors most important in determining whether a patient would be physically restrained were: ability to transfer himself in and out of bed; ability to walk; impairment of mental status; history of hip fracture; nursing staff to patient ratio; and housing on a dementia unit. Pharmacological restraint was more likely for patients with: histories of physically abusive behavior; age of 85 or more; severe impairment of mental status; family visits once or more often each week; housing in facilities with fewer than 200 residents; and the ability to walk. Although dementia care units house a different sort of population than traditional units, and although fewer restraints do not automatically imply better care, it seems that the use of restraints for demented patients in nursing homes could be reduced. (Consumer Summary produced by Reliance Medical Information, Inc.)

Appropriate care of nursing home residents requires accurate assessment of individual needs. It is estimated that more than 50 percent of these residents have some form of dementia. A care planning strategy has been developed that categorizes nursing home residents with dementia based upon four proposed determinants of need: impairment in activities of daily living, behavioral problems, communication abilities, or physical transition. Through case examples, it is shown that evaluating residents in these four areas provides an assessment of their individual needs. When making similar assessments of the nursing home population at large, more general program planning is possible, as is more appropriate staff training. There are instruments that can provide the information needed. In fact, much of the information can be obtained by standard assessments. (Consumer Summary produced by Reliance Medical Information, Inc.)