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

  • Debra G. Morgan (a1) and Norma J. Stewart (a1)


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.

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.



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American Psychological Association. (1987). Diagnostic and statistical manual of mental disorders (DSM III) (3rd ed.). Washington: The Association.
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, 833841.
Aronson, M. (1994). Reshaping dementia care: Practice and policy in long-term care. London: Sage Publications.
Baum, A., & Davis, G. (1980). Reducing the stress of high-density living: An architectural intervention. Journal of Personality and Social Psychology, 38, 471481.
Baum, A., & Paulus, P. (1987). Crowding. In Stokols, D. & Altman, I. (Eds.). Handbook of environmental psychology (Vol 1) (pp. 553570). New York: John Wiley & Sons.
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, 319323.
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, 12291236.
Calkins, M. (1988). Design for dementia: Planning environments for the elderly and confused. Owings Mills, MD: National Health Publishing.
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, 899913.
Chafetz, P. (1991). Behavioral and cognitive outcomes of SCU care. Clinical Gerontologist, 11(1), 1938.
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, 511514.
Coons, D. (1991). Specialized dementia care units. Baltimore, MD: Johns Hopkins University Press.
Crook, T. (1987). Dementia. In Carstensen, L. & Edelstein, B. (Eds.). Handbook of clinical gerontology (pp. 96111). New York: Pergamon Press.
Donat, D. (1986). Altercations among institutionalized psychogeriatric patients. Gerontologist, 26, 227228.
Feinstein, A. (1985). Clinical epidemiology: The architecture of clinical research. London: W.B. Saunders.
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), 399406.
Hall, G., Hirschling, V., & Todd, S. (1986). Sheltered freedom: An Alzheimer's unit in an ICF. Geriatric Nursing, 7(3), 132136.
Health & Welfare Canada. (1991). Designing facilities for people with dementia. Ottawa: Health Facilities Design Unit, Department of National Health and Welfare.
Holmes, D., Teresi, J., Weiner, A., Monaco, C., Eonch, J., & Vickers, R. (1990). The Gerontologist, 30(2), 178183.
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), 349369.
Képpel, G. (1982). Design and analysis: A researcher's handbook (2nd ed.). Englewood Cliffs, NJ: Prentice-Hall.
Kovack, C., & Steams, S. (1994). DSCUs: A Study of behavior before and after residence. Journal of Gerontological Nursing, 20(12), 3339
Lawton, M., Fulcomer, M., & Kleban, M. (1984). Architecture for the mentally impaired elderly. Environment and Behavior, 16(6), 730757.
Lawton, M., & Nahemow, L. (1973). Ecology and the aging process. In Eisdorfer, C. & Lawton, M. (Eds.), Psychology of adult development and aging (pp. 619674). Washington: American Psychological Association.
Lipsey, M. (1990). Design sensitivity: Statistical power for experimental research. Newbury Park, Sage.
Mace, N. (1990). Dementia care: Patient, family, community. Baltimore, MD: Johns Hopkins University Press.
Mathew, L., & Sloane, P. (1991). Environmental characteristics of existing dementia units. In Sloane, P. & Mathew, L. (Eds.), Dementia units in long-term care (pp. 163173). Baltimore: Johns Hopkins University Press.
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, 439447.
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, 939944.
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.
Morgan, D., & Stewart, N. (1997). The importance of the social environment in dementia care. Western Journal of Nursing Research, 19(6), 736758.
Morgan, D., & Stewart, N. (in press-a). Multiple-occupancy vs. private rooms on dementia units. Environment and Behavior.
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.
Nasman, B., Bucht, G., Eriksson, S., & Sandman, O. (1993). Behavioral symptoms in the institutionalized elderly: Relationship to dementia. International Journal of Geriatric Psychiatry, 8, 843849.
Negley, E., & Manley, J. (1990). Environmental interventions in assaultive behavior. Journal of Gerontological Nursing, 16(3), 2933.
Ohta, R., & Ohta, B. (1988). Special care units for Alzheimer's Disease patients: A critical look. The Gerontologist, 28(6), 803808.
Proshansky, H., Ittleson, W., & Rivlin, L. (1976). Environmental psychology: People and their physical settings. New York: Holt, Rinehart, & Winston.
Reisberg, B., Ferris, S., DeLeon, M., & Crook, T. (1982). The Global Deterioration Scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 11361139.
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, 95112.
Rockwood, K., Stolee, P., & Robertson, D. (1989). The prevalence of cognitive impairment in an elderly Canadian population. Acta Psychiatrica Scandinavia, 80, 303309.
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, 7782.
Ryden, M., Bossenmaier, M., & McLachlan, C. (1991). Aggressive behavior in cognitively impaired nursing home residents. Research in Nursing and Health, 14, 8795.
SPSS for Windows (1993). Statistical package for the social sciences, Base System User's Guide, Release 6.0. Chicago, IL: SPSS inc.
Stevens, J. (1992). Applied multivariate statistics for the social sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.
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.
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), 292299.
Tabachnick, B., & Fidell, L. (1989). Using multivariate statistics. New York: Harper and Row.
Tate, J. (1980). The need for personal space in institutions for the elderly. Journal of Gerontological Nursing, 6(8), 439449.
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, 109116.
Weinrick, S., Egbert, C., Eleazer, P., & Haddock, S. (1995). Agitation: Measurement, management, and intervention research. Archives of Psychiatric Nursing, 5(5), 251260.
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.
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, 524531.
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), 169180.
Zimmer, J., Watson, N., & Treat, A. (1984). Behavioral problems among patients in skilled nursing facilities. American Journal of Public Health, 74(10), 11181121.



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