Comparison of Characteristics of Nursing Homes and Other Residential Long-term Care Settings for People with Dementia: Comparative Effectiveness Review Number 79

Dementia is a group of neurological conditions that lead to gradual decline in mental function. It is the most common reason for entry into long-term care settings such as nursing homes and residential care/assisted living. The majority of care for people with dementia is provided in the community by family members; however, increasing care needs in later stages of the illness often lead to placement in a long-term care setting. Because long-term care settings are highly varied, people with dementia and their families would benefit from evidence-based guidance on what to choose from the available options. Dementia is a syndrome with multiple causes characterized by a decline in mental function, marked most commonly by memory impairment and a reduction in at least one other area of cognitive function, such as reasoning, judgment, abstract thought, comprehension, learning, task execution, and use of language. The most common type of dementia is Alzheimer?s disease; other types include vascular dementia, mixed dementia, dementia with Lewy bodies, and frontotemporal dementia. Dementia causes significant morbidity and mortality and creates a substantial burden on the people affected, as well as on caregivers, health systems, and society. Dementia gradually erodes the individual?s ability to make decisions; manage personal affairs; and eventually do even simple tasks. Late stages of dementia are characterized by weight loss, limited mobility, and frequent infections so that, unless some other illness is fatal sooner, dementia will lead to death. The course of dementia from diagnosis to death is variable but typically 8 to 12 years. Costs of dementia care, including both medical care and informal caregiver time, are estimated at more than $148 billion in the U. S annually. One relevant question to ask is whether one type of long-term care setting is superior to another for dementia overall or for certain subgroups of people with dementia. Considering the central role of family caregivers in deciding which NH or other residential long-term care setting to choose when home care is no longer feasible, information on which components of these settings relate to better outcomes would be very helpful. Different long-term care settings offer different care and services, and no comprehensive evidence-based guidance exists that identifies which characteristics or settings are best for which type of person based on age, symptom severity, or other characteristics. The objective of this review is to provide information that would help families who are trying to decide where to place a family member who has dementia and who can no longer be cared for at home. This review sought to address the following Key Questions: KQ 1. What is the effectiveness of organizational characteristics, structures, or processes of care in nursing homes and other residential long-term care settings for improving health outcomes for people with dementia? KQ 2. What is the effectiveness of organizational characteristics, structures, or processes of care in nursing homes and other residential long-term care settings for improving psychosocial outcomes for people with dementia? KQ 3. What is the effectiveness of organizational characteristics, structures, or processes of care in nursing homes and other residential long-term care settings for improving health outcomes for informal caregivers of people with dementia? KQ 4. What is the effectiveness of organizational characteristics, structures, or processes of care in nursing homes and other residential long-term care settings for improving psychosocial outcomes for informal caregivers of people with dementia? KQ 5. Does the effect of organizational characteristics, structures, or processes of care on health and psychosocial outcomes vary by the characteristics of the person with dementia (e.g., severity of dementia, functional status) or of the informal caregiver (e.g., age, relationship, health status)?