SPECIAL CARE UNITS FOR DEMENTIA IN NURSING-HOMES - A CONTROLLED-STUDYOF EFFECTIVENESS

The management of behavioral disturbances in the demented patient is a debated issue both in the medical and the social fields. Aim of this study was to evaluate the effectiveness of an integrated model of care [special care units = SCU in long-term care facilities] to control be havioral disturbances in dementia and to compare it to the more tradit ional nursing home model. The study is multinational [Italy, France an d Sweden] and is funded by the European Commission (DG V). Thirty-one cases (in SCU) and 35 controls (in traditional nursing homes = NH) wer e enrolled in 43 long-term facilities and assessed 7-14 days after adm ission and 3 months afterwards. On admission, cases and controls had s imilar sociodemografic status, cognition, diagnoses, somatic health, a nd psychotropic drug use, but the former tended to have more severe be havioral disturbances and to be less restrained (19 versus 46 %) over the first week after admission. On 3-month follow-up, behavioral distu rbances had improved in cases and controls, but with a different patte rn: delusions, hallucinations, and agitation improved in the former, a nd anxiety, euphoria/elation, and irritability/lability in the latter. Sleep disturbances improved in both groups and depression improved in cases and worsened in the controls. Psychotropic drug prescription ha d not significantly changed in either group. However, notwithstanding the higher frequency of physical restraint use in the controls soon af ter admission, on 3-month follow-up this was even greater (69 %), whil e it remained low (26 %) in the cases. The data suggest that special c are unit care of behavioral disturbances in the demented can succesful ly control symptoms without additional psychotropic drug and restraint use.