Impact of Dementia on Quality of Care in Nursing Homes

We examined how facility-level prevalence of dementia affects quality of care for residents with and without dementia in nursing homes (NHs).

Data sources included Medicare beneficiary enrollment file, Medicare hospital claims, the Minimum Data Set, and data from LTCFocus.org. Study population included 1,104,637 long-term care residents from 14,178 NHs in 2007.

Urinary incontinence (UI), depressive/anxious symptoms (DA), and potentially avoidable hospitalizations (PAH) were the quality measures (QMs) examined. The key independent variable, facilities’ prevalence of dementia, was categorized into three groups: low (<37%); medium (37%-67%, reference); and high (>67%).

We fit logistic (QM=UI, DA) and Poisson (QM=PAH) regression models with facility random-effects. One third of residents deteriorated in UI in the first quarter; 14% became more depressed or anxious between two assessments; and 18% experienced at least one PAH within a year.  In NHs with low prevalence of dementia, residents with dementia had a reduced risk of deterioration in UI (OR=0.88, 95%CI=0.82-0.94) and DA (OR=0.90, 95%CI=0.85-0.94), as did residents without dementia (UI: OR=0.95, 95%CI=0.90-1.00; DA: OR=0.89, 95%CI=0.85-0.93), compared to residents in NHs with medium dementia prevalence. In NHs with high prevalence of dementia, residents with dementia had a reduced risk of PAHs (IRR=0.97, 95%CI=0.94-1.00), while residents without dementia had an increased risk of deterioration in DA (OR=1.08, 95%CI=1.03-1.13).

NHs with high dementia prevalence appear to provide better quality of care to residents with dementia. However, facilities with few dementia residents seem to provide better quality to both populations. Future research should explore the benefits of operating special dementia care facilities.