Dementia programme effectiveness in long-term care

Objective. To examine the effectiveness of dementia programmes and report factors related to programme outcomes. To describe the characteristics which placed hostel residents at risk for nursing home placement and to measure changes in dependencies and impairments over 2 years. Design. Longitudinal, quasi-experimental using in situ resident groups matched on resident and facility characteristics. Setting. Australian hostels for the elderly. Subjects. 587 residents (programme group N = 184, comparison group N = 162, frail groups N = 241). Measures. Mini-Mental Stale Examination, Geriatric Depression Scale and staff-rated indices of functioning, including activities of daily living, problem behaviours, psychiatric symptomology and health status, were used to monitor changes in resident characteristics. Time to nursing home placement was another outcome measure. Results. Residents in hostel dementia programmes remained significantly longer than those in the comparison group (2.5 months over 2 years) before exit to a nursing home. Quality of life for residents in dementia programmes was enhanced through higher levels of social contact with relatives and lower reported levels of depressive symptoms. Conclusions. Dementia programmes worked, but the reasons why were more difficult to establish. The programmes did not appear to modify the capacities of residents by slowing rates of decline. Dementia programmes provided specialist (non-personal care) staff focusing on the social and emotional needs of residents. These staff provided appropriate, targeted activities for residents with dementia, had a clearly defined role directed exclusively to these residents and felt directly responsible for them. Dementia programmes produced a system effect. They increased the capacity of hostels to care for residents with dementia for longer periods, before admission to a nursing home.