Annals of Long Term Care

Special Care Facility Compared with Traditional Environments for Dementia Care: A Longitudinal Study of Quality of Life

Marlene A. Reimer, RN, PhD, Susan Slaughter, RN, MSc(A), Cam Donaldson, PhD, Gillian Currie, PhD, and Michael Eliasziw, PhD

Objectives: To compare the effect of a specialized care facility (SCF) on quality of life (QoL) for residents with middle- to late-stage dementia over a 1-year period with residence in traditional institutional facilities.

Design: A prospective, matched-group design with assessments of QoL every 3 months for 1 year.

Setting: Twenty-four long-term care centers and four designated assisted living environments in an urban center in western Canada.

Participants: One hundred eighty-five residents with Global Deterioration Scores of 5 or greater were enrolled: 62 in the intervention SCF group and 123 in the traditional institutional facilities groups.

Intervention: The SCF is a 60-bed purpose-built facility with 10 people living in six bungalows. The facility followed an ecologic model of care that is responsive to the unique interplay of each person and the environment. This model encompasses a vision of long-term care that is more comfortable, more like home, and offers more choices, meaningful activity, and privacy than traditional settings.

Measurements: QoL outcomes were assessed using the Brief Cognitive Rating Scale, Functional Assessment Staging, Cohen-Mansfield Agitation Inventory, Pleasant Events Scale—Alzheimer’s disease, Multidimensional Observation Scale of Elderly Subjects, and Apparent Affect Rating Scale.

Results: The intervening SCF group demonstrated less decline in activities of daily living, more sustained interest in the environment, and less negative affect than residents in the traditional institutional facilities. There were no differences between groups in concentration, memory, orientation, depression, or social withdrawal.

Conclusion: The present study suggests that QoL for adults with middle- to late-stage dementia is the same or better in a purpose-built and staffed SCF than in traditional institutional settings. J Am Geriatr Soc 2004;52(7): 1085-1092.

Office Evaluation and Treatment of Elderly Patients with Acute Bronchitis

Michael A. Steinman, MD, Angela Sauaia, MD, PhD, Judy H. Maselli, MSPH, Peter M. Houck, MD, and Ralph Gonzales, MD, MSPH

Objectives: To assess the office evaluation of seniors with uncomplicated acute bronchitis and to determine the association between elements of the clinical evaluation and antibiotic prescribing decisions.

Design: Cross-sectional chart review.

Setting: Seventy-seven community-based office practices in the Denver metropolitan area.

Participants: Elderly fee-for-service Medicare patients.

Measurements: Medicare administrative data to identify patients with acute bronchitis; medical record review to confirm the diagnosis and record other clinical data.

Results: Of 198 elderly patients with acute bronchitis, the mean age ± standard deviation was 76 ± 8.6; 53% had at least one comorbid condition. Clinically important vital signs were frequently not recorded; temperature was missing from 34% of charts and pulse from 50% of charts. When recorded, significant vital sign abnormalities were uncommon, with 7% having a temperature of 100°F and 8% having a pulse of 100 beats per minute or greater. However, antibiotics were prescribed to 83% of patients, with more than half of these prescriptions being for extended-spectrum antibiotics. Treatment with antibiotics was more common in men than women (92% vs 78%, P = 0.007) but was not associated with clinical factors including vital sign measurement, vital sign results, chest radiography, patient age, duration of illness, or the presence of comorbidities.

Conclusion: The vast majority of seniors with acute bronchitis are treated with antibiotics, regardless of patient characteristics or the type of evaluation received.