Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-04T21:12:43.879Z Has data issue: false hasContentIssue false
  • English
  • Français

High versus Low Density Special Care Units: Impact on the Behaviour of Elderly Residents with Dementia

Published online by Cambridge University Press:  29 November 2010

Debra G. Morgan  and
Norma J. Stewart
Debra G. Morgan
Affiliation:
University of Saskatchewan
Norma J. Stewart
Affiliation:
University of Saskatchewan
Get access Rights & Permissions [Opens in a new window]

Abstract

The opening of a new Special Care Unit provided the opportunity to study the effect of reduced social density (fewer residents) and spatial density (more area per person) on the behaviour of residents with dementia. Two groups (N = 64) were observed at three periods spaced six months apart. As hypothesized, there was a greater improvement in Disruptive and Nondisruptive behaviour in the experimental group (move from high to low density) compared to the comparison group (constant high density). Findings suggest that unit density is an important determinant of behaviour in elderly residents with dementia.

Résumé

L'ouverture d'une nouvelle unité de soins spéciaux a permis d'étudier l'effet de la densité sociale réduite (moins de résidents) et de la densité spatiale (plus d'espace par personne) sur le comportement de résidents avec démence. Deux groupes (N = 64) ont été observés pendant trois périodes espacées de six mois chacune. Tel que théorisé, il y a eu plus d'amélioration dans le comportement perturbateur et non perturbateur du groupe expérimental (passant de haute à basse densité) par rapport au groupe de comparaison (haute densité constante). Les résultats indiquent que la densité de l'unité résidentielle est un déterminant important pour le comportement des résidents âgés avec démence.

Keywords

Long-Term CareDisruptive BehaviourDensity.Soins de longue duréecomportement perturbateurdensité.
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 17 , Issue 2 , Été/Summer 1998 , pp. 143 - 165
Copyright
Copyright © Canadian Association on Gerontology 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychological Association. (1987). Diagnostic and statistical manual of mental disorders (DSM III) (3rd ed.). Washington: The Association.Google Scholar
Annerstedt, L., Gustafson, L., & Nilsson, K. (1993). Medical outcome of psychosocial intervention in demented patients: One year clinical follow-up after relocation into group living units. International Journal of Geriatric Psychiatry, 8, 833–841.CrossRefGoogle Scholar
Aronson, M. (1994). Reshaping dementia care: Practice and policy in long-term care. London: Sage Publications.Google Scholar
Baum, A., & Davis, G. (1980). Reducing the stress of high-density living: An architectural intervention. Journal of Personality and Social Psychology, 38, 471–481.CrossRefGoogle ScholarPubMed
Baum, A., & Paulus, P. (1987). Crowding. In Stokols, D. & Altman, I. (Eds.). Handbook of environmental psychology (Vol 1) (pp. 553–570). New York: John Wiley & Sons.Google Scholar
Benson, D., Cameron, D., Humback, E., Servino, L., & Gamberi, S. (1987). Establishment and impact of a dementia unit within the nursing home. Journal of the American Geriatrics Society, 35, 319–323.CrossRefGoogle ScholarPubMed
Berg, L., Buckwalter, K., Chafetz, P., Gwyther, L., Holmes, D., Koepke, K., Lawton, M., Lindeman, D., Magaziner, J., Maslow, K., Morley, J., Ory, M., Rabins, P., Sloane, P., & Teresi, J. (1991). Special care units for persons with dementia. Journal of the American Geriatric Society, 39, 1229–1236.CrossRefGoogle ScholarPubMed
Calkins, M. (1988). Design for dementia: Planning environments for the elderly and confused. Owings Mills, MD: National Health Publishing.Google Scholar
Canadian Study of Health and Aging Working Group. (1994). Canadian Study of Health and Aging: Study methods and prevalence of dementia. Canadian Medical Association Journal, 150, 899–913.Google Scholar
Chafetz, P. (1991). Behavioral and cognitive outcomes of SCU care. Clinical Gerontologist, 11(1), 19–38.CrossRefGoogle Scholar
Cleary, T., Clamon, C., Price, M., & Shullaw, G. (1988). A reduced stimulation unit: Effects on patients with Alzheimer's disease and related disorders. Gerontologist, 28, 511–514.CrossRefGoogle ScholarPubMed
Coons, D. (1991). Specialized dementia care units. Baltimore, MD: Johns Hopkins University Press.Google Scholar
Crook, T. (1987). Dementia. In Carstensen, L. & Edelstein, B. (Eds.). Handbook of clinical gerontology (pp. 96–111). New York: Pergamon Press.Google Scholar
Donat, D. (1986). Altercations among institutionalized psychogeriatric patients. Gerontologist, 26, 227–228.CrossRefGoogle ScholarPubMed
Feinstein, A. (1985). Clinical epidemiology: The architecture of clinical research. London: W.B. Saunders.Google Scholar
Hall, G., & Buckwalter, K. (1987). Progressively lowered stress threshold: A conceptual model for care of adults with Alzheimer's disease. Archives of Psychiatric Nursing, 1(6), 399–406.Google ScholarPubMed
Hall, G., Hirschling, V., & Todd, S. (1986). Sheltered freedom: An Alzheimer's unit in an ICF. Geriatric Nursing, 7(3), 132–136.CrossRefGoogle Scholar
Health & Welfare Canada. (1991). Designing facilities for people with dementia. Ottawa: Health Facilities Design Unit, Department of National Health and Welfare.Google Scholar
Holmes, D., Teresi, J., Weiner, A., Monaco, C., Eonch, J., & Vickers, R. (1990). The Gerontologist, 30(2), 178–183.CrossRefGoogle Scholar
Jackson, M., Drugovich, M., Fretwell, M., Spector, W., Sternberg, W., & Rosenstein, R. (1989). Prevalence and correlates of disruptive behavior in the nursing home. Journal of Aging and Health, 1(3), 349–369.CrossRefGoogle Scholar
Képpel, G. (1982). Design and analysis: A researcher's handbook (2nd ed.). Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
Kovack, C., & Steams, S. (1994). DSCUs: A Study of behavior before and after residence. Journal of Gerontological Nursing, 20(12), 33–39CrossRefGoogle Scholar
Lawton, M., Fulcomer, M., & Kleban, M. (1984). Architecture for the mentally impaired elderly. Environment and Behavior, 16(6), 730–757.CrossRefGoogle Scholar
Lawton, M., & Nahemow, L. (1973). Ecology and the aging process. In Eisdorfer, C. & Lawton, M. (Eds.), Psychology of adult development and aging (pp. 619–674). Washington: American Psychological Association.CrossRefGoogle Scholar
Lipsey, M. (1990). Design sensitivity: Statistical power for experimental research. Newbury Park, Sage.Google Scholar
Mace, N. (1990). Dementia care: Patient, family, community. Baltimore, MD: Johns Hopkins University Press.Google Scholar
Mathew, L., & Sloane, P. (1991). Environmental characteristics of existing dementia units. In Sloane, P. & Mathew, L. (Eds.), Dementia units in long-term care (pp. 163–173). Baltimore: Johns Hopkins University Press.Google Scholar
Mathews, E., Farrell, G., & Blackmore, A. (1996). Effects of an environmental manipulation emphasizing client-centred care on agitation and sleep in dementia sufferers in a nursing home. Journal of Advanced Nursing, 24, 439–447.CrossRefGoogle Scholar
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., & Stadlan, E. (1984). Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA work group. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
Morgan, D. (1996). Impact of high versus low density special care units on the behavior of elderly residents with dementia. Unpublished doctoral dissertation. University of Saskatchewan, Saskatoon, SK.Google Scholar
Morgan, D., & Stewart, N. (1997). The importance of the social environment in dementia care. Western Journal of Nursing Research, 19(6), 736–758.CrossRefGoogle Scholar
Morgan, D., & Stewart, N. (in press-a). Multiple-occupancy vs. private rooms on dementia units. Environment and Behavior.Google Scholar
Morgan, D., & Stewart, N. (in press-b). The physical environment of special care units. Needs of residents with dementia from the perspective of staff and family caregivers. Qualitative Health.Google Scholar
Nasman, B., Bucht, G., Eriksson, S., & Sandman, O. (1993). Behavioral symptoms in the institutionalized elderly: Relationship to dementia. International Journal of Geriatric Psychiatry, 8, 843–849.CrossRefGoogle Scholar
Negley, E., & Manley, J. (1990). Environmental interventions in assaultive behavior. Journal of Gerontological Nursing, 16(3), 29–33.CrossRefGoogle ScholarPubMed
Ohta, R., & Ohta, B. (1988). Special care units for Alzheimer's Disease patients: A critical look. The Gerontologist, 28(6), 803–808.CrossRefGoogle ScholarPubMed
Proshansky, H., Ittleson, W., & Rivlin, L. (1976). Environmental psychology: People and their physical settings. New York: Holt, Rinehart, & Winston.Google Scholar
Reisberg, B., Ferris, S., DeLeon, M., & Crook, T. (1982). The Global Deterioration Scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 1136–1139.Google ScholarPubMed
Reisberg, B., Franssen, E., Sclan, S., Kluger, A., & Ferris, S. (1989). Stage specific incidence of potentially remediable behavioral symptoms in aging and Alzheimer disease. Bulletin of Clinical Neurosciences, 54, 95–112.Google Scholar
Rockwood, K., Stolee, P., & Robertson, D. (1989). The prevalence of cognitive impairment in an elderly Canadian population. Acta Psychiatrica Scandinavia, 80, 303–309.Google Scholar
Rovner, B., Lucas-Blaustein, J., Folstein, M., & Smith, S. (1990). Stability over one year in patients admitted to a nursing home dementia unit. International Journal of Geriatric Psychiatry, 5, 77–82.CrossRefGoogle Scholar
Ryden, M., Bossenmaier, M., & McLachlan, C. (1991). Aggressive behavior in cognitively impaired nursing home residents. Research in Nursing and Health, 14, 87–95.CrossRefGoogle ScholarPubMed
SPSS for Windows (1993). Statistical package for the social sciences, Base System User's Guide, Release 6.0. Chicago, IL: SPSS inc.Google Scholar
Stevens, J. (1992). Applied multivariate statistics for the social sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
Stewart, N., Hiscock, M., Morgan, D., Murphy, P., & Yamamoto, M. (in press). Development and psychometric evaluation of the Envionment-Behavior Interaction Code (EBIC). Nursing Research.Google Scholar
Swanson, E., Maas, M., & Buckwalter, K. (1993). Catastrophic reactions and other behaviors of Alzheimer's residents: Special unit compared with traditional unit. Archives of Psychiatric Nursing, 7(5), 292–299.CrossRefGoogle Scholar
Tabachnick, B., & Fidell, L. (1989). Using multivariate statistics. New York: Harper and Row.Google Scholar
Tate, J. (1980). The need for personal space in institutions for the elderly. Journal of Gerontological Nursing, 6(8), 439–449.CrossRefGoogle ScholarPubMed
Teri, L., Borson, S., Kiyak, A., & Yamagishi, M. (1989). Behavioral and cognitive dysfunction, and functional skill: Prevalence and relationship in Alzheimer's disease. Journal of the American Geriatrics Society, 37, 109–116.Google ScholarPubMed
Weinrick, S., Egbert, C., Eleazer, P., & Haddock, S. (1995). Agitation: Measurement, management, and intervention research. Archives of Psychiatric Nursing, 5(5), 251–260.CrossRefGoogle Scholar
Weisman, G., Cohen, U., Day, K., & Meyer, G. (1990). Programming and design for dementia: Development of a 50-person residential environment. Milwaukee, WI: Center for Architecture and Urban Planning Research.Google Scholar
Wells, Y., & Jorm, A. (1987). Evaluation of a special nursing home unit for dementia sufferers: A randomised controlled comparison with community care. Australian and New Zealand Journal of Psychiatry, 21, 524–531.CrossRefGoogle ScholarPubMed
Wimo, A., Nelvig, A., Nelvig, J., Adolffson, R., Mattsson, B., & Sandman, P. (1993). Can changes in ward routine affect the severity of dementia? A controlled prospective study. International Psychogeriatrics, 5(2), 169–180.CrossRefGoogle ScholarPubMed
Zimmer, J., Watson, N., & Treat, A. (1984). Behavioral problems among patients in skilled nursing facilities. American Journal of Public Health, 74(10), 1118–1121.CrossRefGoogle ScholarPubMed