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Charles D. Phillips, PhD, MPH; Philip D. Sloane, MD, MPH; Catherine Hawes, PhD; Gary Koch, PhD; Julie Han, MHS; Kathleen Spry, PhD; George Dunteman, PhD; Rick L. Williams, PhD

JAMA. 1997;278(16):1340-1344.

Abstract
Context.
—Alzheimer disease special care units (SCUs) in nursing homes are increasingly prevalent, but little is known about their effects on residents' outcomes.

Objective.
—To analyze the effect of SCU residence on the rates at which residents decline in functional status.

Design.
—A cohort of nursing home residents assessed at multiple points during about 1 year. Facility staff completed all assessments using the Minimum Data Set for Nursing Home Resident Assessment and Care Screening (MDS).

Setting.
—Medicare-or Medicaid-certified nursing facilities.

Patients or Other Participants.
—All nursing home residents in 1993 and early 1994 in Kansas, Maine, Mississippi, and South Dakota. Serial MDS assessments of 77 337 residents in more than 800 facilities, including 1228 residents in 48 facilities with SCUs.

Main Outcome Measures.
—Decline in locomotion, transferring, toileting, eating, dressing, and a summary activities of daily living index; decline in urinary and bowel continence; and significant weight loss.

Results.
—No statistically significant difference was observed in the speed of decline for residents in SCUs and traditional units in any of the 9 outcomes. Residents were matched on a variety of characteristics, and subgroup analyses were performed. In none did we observe a pattern of better outcomes among SCU residents.

Conclusions.
—Although SCUs may have provided unmeasured benefits to families and residents, it does not appear that those benefits included any slowing in the rates of functional decline experienced by individuals with dementia.

Author Affiliations
From the Myers Research Institute, Menorah Park Center for the Aging, Beachwood, Ohio (Drs Phillips and Spry); the Departments of Family Medicine (Dr Sloane) and Biostatistics (Dr Koch), University of North Carolina at Chapel Hill; and the Program on Aging and Long-term Care (Dr Hawes and Ms Han) and Statistics Research Division (Drs Dunteman and Williams), Research Triangle Institute, Research Triangle Park, NC.

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