CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Department of Health Care and Nursing Science, Maastricht University, the Netherlands.
J Am Med Dir Assoc. 2010 Nov;11(9):662-70. doi: 10.1016/j.jamda.2010.08.001.
The purpose of this study was to evaluate the effects of small-scale living facilities in dementia care on residents, family caregivers, and staff.
This was a quasi-experimental study including 2 types of institutional nursing care: small-scale living facilities (experimental group), and regular psychogeriatric nursing home wards (control group). Three measures were conducted: at baseline and follow-ups after 6 and 12 months.
Twenty-eight houses in small-scale living facilities and 21 regular psychogeriatric nursing home wards.
In total, 259 residents were included in the study: 124 in small-scale living facilities and 135 controls, matched on cognitive and functional status. Furthermore, 229 family caregivers were included and 305 staff members.
For residents, main outcome measures were quality of life, neuropsychiatric symptoms, and agitation. Main outcome measures for family caregivers included perceived burden, satisfaction, and involvement with care. Main outcome measures for staff were job satisfaction and motivation.
No effects were found for residents' total quality of life, neuropsychiatric symptoms, and agitation. Family caregivers in small-scale living reported significantly less burden (adjusted mean difference 0.8, 95% CI 0.1-1.5) and were more satisfied with nursing staff (0.3, 0.2-0.5) than family caregivers in regular wards. No differences were found in their involvement with care. Overall, no significant differences were found for staff's job satisfaction and motivation, although subgroup analyses using contrast groups (regarding typical small-scale living and regular wards) revealed more job satisfaction (2.0, 0.5-3.5) and motivation (0.6, 0.0-1.3) in small-scale living compared with regular wards.
This study was unable to demonstrate convincing overall effects of small-scale living facilities. Because governmental policies and, in some countries, financial support, are increasingly aimed at providing small-scale, homelike care, it is suggested that this may not be a final solution to accomplish high-quality dementia care and that other options should be considered.
本研究旨在评估痴呆护理中小规模生活设施对居民、家庭照顾者和工作人员的影响。
这是一项准实验研究，包括 2 种机构护理：小规模生活设施（实验组）和常规精神科养老院病房（对照组）。采用 3 种措施：基线和 6 个月及 12 个月后的随访。
28 个小规模生活设施和 21 个常规精神科养老院病房。
共有 259 名居民参与了这项研究：124 名在小规模生活设施，135 名对照，在认知和功能状态上相匹配。此外，纳入了 229 名家庭照顾者和 305 名工作人员。
对于居民，主要结局指标是生活质量、神经精神症状和激越。家庭照顾者的主要结局指标包括感知负担、满意度和对护理的参与程度。工作人员的主要结局指标是工作满意度和积极性。
居民的总生活质量、神经精神症状和激越均无明显改善。小规模生活设施中的家庭照顾者报告的负担明显较轻（调整平均差异为 0.8，95%可信区间为 0.1-1.5），对护理人员的满意度也较高（0.3，0.2-0.5），与常规病房的家庭照顾者相比。他们对护理的参与程度没有差异。总体而言，工作人员的工作满意度和积极性没有显著差异，尽管使用对照群体（关于典型的小规模生活和常规病房）进行亚组分析显示，小规模生活设施的工作满意度（2.0，0.5-3.5）和积极性（0.6，0.0-1.3）高于常规病房。
本研究未能证明小规模生活设施具有令人信服的整体效果。由于政府政策和一些国家的财政支持越来越倾向于提供小规模、家庭式的护理，因此，这可能不是实现高质量痴呆护理的最终解决方案，应该考虑其他选择。
