Objective: To determine the benefits of a 'home for life' model compared to a 'rehabilitation and relocation' model in residential care for people with dementia complicated by severe behavioral and psychological symptoms (BPSD).
Design: A comparative cohort study with repeated assessments over one year.
Materials and Methods: 61 patients with dementia fulfilling local health authority criteria for continuing care admitted over an 18 month period to nursing homes in South London; 37 in the 'Home for Life' group and 24 in the intermediate care group. All patients were assessed at admission, and then after 6, 14, 28 and 54 weeks. Information was obtained from patients' relatives and nursing care staff. Severity of dementia was assessed using the Mini-Mental State Examination and Functional Assessment Staging. Prevalence and severity of BPSD were identified using the Behavioural Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD). Activities of Daily Living were rated using the Bathel Index. Physical health and medication use was also recorded. Main outcome measures were the total and subscale scores of the BEHAVE-AD and the time from admission to death. Data were analyzed using ANOVA with repeated measures and survival analysis.
Results: Patients admitted to the intermediate care group initially had lower scores on the BEHAVE-AD than the home for life group. Scores in both groups increased over the year, although there was a trend for intermediate care patients to worsen. However, patients in the intermediate group moving on to a new nursing home showed a further deterioration in behavior following the move. Use of neuroleptic medication increased significantly in the intermediate group but this was unrelated to therapeutic outcome. Overall, 28% of patients died during the year-long follow-up period. Cox's regression analysis demonstrated that survival was reduced in men, in patients with lower Barthel scores on admission, in the intermediate care group patients and in those who did not move to a new home. Severity of dementia, physical ill-health, BEHAVE-AD scores and medication use had no influence on survival.
Conclusion: Although no major differences were found between the two models of care, this study confirms the disruptive effects of further re-location for patients with severe dementia.
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