PARTNERSHIP NURSING HOME CAREFOR DEMENTIA: THE GLASGOW

EXPERIENCEÐONE-YEARFOLLOW-UP

DONALD LYONS�1, MARK COHEN2, TOM HENDERSON3 AND NICK WALKER4

1Consultant Psychiatrist, Leverndale Hospital, Glasgow, UK2Sta� Grade Psychiatrist, Goldenhill Resource Centre, Glasgow, UK

3Senior Registrar in Psychiatry, West of Scotland Training Scheme, UK4Registrar in Psychiatry, Ayrshire and Arran Training Scheme, UK

ABSTRACT

The outcome of the transfer of 60 elderly patients su�ering from dementia from hospital to nursing home care under apartnership contract was reviewed at 6 and 12 months following transfer. The nursing home population had faredbadly compared with patients remaining in hospital during the ®rst 3 months. This di�erence was less evident at6 months follow-up and had disappeared at 12 months follow-up. It seems that a partnership agreement such as thiscan deliver a quality of health care at least as good as hospital treatment as long the transfer is handled carefully.# 1997 John Wiley & Sons Ltd.

Int. J. Geriat. Psychiatry, 12, 838±840 (1997)No. of Figures: 0. No. of Tables: 1. No. of References: 5.

KEY WORDSÐdementia; nursing homes; patient transfer; quality of health care; long-term care

A previous article (Lyons et al., 1995) examined thetransfer of elderly mentally ill people from hospitalto partnership nursing home care. In comparisonwith patients remaining in hospital, the nursinghome patients exhibited a greater decline infunctional ability and a signi®cant excess ofpressure sores during the ®rst 3 months of theirstay. In order to determine whether the situationwould resolve and was merely an e�ect of themethod of transfer and teething problems in anursing home or whether nursing home care waso�ering a poorer standard of care than hospitalcare, the sample was reviewed at 6 months and12 months.

Under the partnership contract, the privatecompany owning the nursing home was responsiblefor nursing care, hotel services and patients'activities. The Health Board retained responsibilityfor medical care, pharmacy and physiotherapy.Either directly or indirectly, all aspects of patient

care were purchased by the Board and there was nocharging or means testing.

METHOD

The method is described in detail in our previousarticle. Surviving patients out of 60 transferred tonursing home care and 60 remaining in hospitalwere compared at 6 and 12 months. Both samplesconsisted largely of people with dementia andwere comparable in terms of age, sex, diagnosis,severity of dementia and severity of functionaldisability. The outcome measures studied weredeath, deterioration in total modi®ed CrichtonRoyal Behavioural Rating Scale (MRCBRS)(Evans et al., 1981), falls, infections, pressure soresand changes in the administration of psychotropicmedication. To minimize reporting bias, falls wereonly recorded if they were severe enough to meritspeci®c medical attention, eg sutures, X-ray orgeneral hospital treatment. The MCRBRS wasbeing used for clinical purposes in the department.

�Correspondence to: Dr D. Lyons, Leverndale Hospital,510 Crookston Road, Glasgow G53 7TU, UK.

CCC 0885±6230/97/080838±03$17.50 Received 21 March 1996# 1997 John Wiley & Sons, Ltd. Accepted 21 January 1997

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, VOL. 12: 838±840 (1997)

In the context of the study, it was used to comparethe levels of functional disability in the two groupsat the outset of the study and the ®nding reportedby us (Lyons et al., 1995) of a signi®cant decline infunctional level as measured by this scale within the®rst 3 months of transfer was surprising.

RESULTS

Table 1 demonstrates the outcome of both groupsat 6 and 12 months with, where appropriate, con®-dence intervals for the excess of pathology in thenursing home population. At 6 months, thenursing home population was faring worse thanthe population remaining in hospital in terms offalls, infections and sores but these di�erences wereno longer evident at 12 months, when the survivingpopulation in nursing home care seemed to befaring slightly better. The dramatic decline is in thenumber of pressure sores in the nursing group,which fell from 16 out of 54 patients at 6 weeks(Lyons et al., 1995) to two out of 33 at 52 weeks.The two other interesting and encouraging featureswere the reductions in psychotropic medicationover time in both the nursing home and hospitalpopulations and the fact that the functional level ofthe surviving patients, as measured by theMCRBRS, improved in the survivors in nursinghomes and became slightly but not signi®cantlybetter in the patients remaining in hospital.

DISCUSSION

Our ®ndings suggest that, after initial problems, thepatients transferred to partnership nursing homeaccommodation fared well and that the care at least

equalled that of patients remaining in hospital.This is in keeping with other studies publishedrecently. Bowling et al. (1993) studied randomizedallocation to hospital or nursing home care andfound no di�erence in mortality. Harwood andEbrahim (1992) found that a well-planned transferdid not harm patients and McAuslane andSperlinger (1994) found no increase in behaviourproblems when patients were relocated. In this laststudy, it was the sta� who moved with the patientswho su�ered the stress!

The previously reported high turnover ofuntrained sta� diminished greatly after the ®rst3 months of the nursing home opening and thismay have been a major factor in maintainingstability and improving patient care. Also, there isno evidence that medication was overused innursing home patients.

We conclude that the use of partnership accom-modation for elderly patients with dementia doesnot prove harmful to their care. However, fewstudies have examined, as we did, the e�ect inpatients within the ®rst 3 months of transfer,when problems were very much apparent. Thishas implications for clinical care and for futureresearch.

REFERENCES

Bowling, A., Formbry, J. and Grant, K. (1993) Factorsassociated with mortality in National Health ServiceNursing homes for elderly people and long staygeriatric wards in hospital. Int. J. Geriatr. Psychiat.8, 203±210.

Evans, D., Jolley, D. and Wilkinson, D. (1981) TheManagement of Mental and Physical Impairment inNon-Specialised Residential Homes for the Elderly.Research Report No 4, University of ManchesterDepartment of Psychiatry and Community Medicine.

Table 1. Outcome at 6 and 12 months

6 months 12 months

NH Hosp. Di�erence NH Hosp. Di�erence

(NH±hosp. 95% CI) (NH±hosp. 95% CI)

Deaths 27% 25% ÿ14%±28% 45% 40% ÿ13%±23%

Falls 25% 16% ÿ8%±26% 18% 24% ÿ25%±13%

Infections 43% 28% ÿ5%±35% 27% 38% ÿ33%±11%

Sores 14% 7% ÿ6%±20% 6% 3%

Sedation:

More 9% 12% 9% 6%

Same 52% 53% 55% 53%

Less 39% 35% 35% 42%

MCRBRS change (mean) �2:61 �2:65 �2:15 �2:21

# 1997 John Wiley & Sons, Ltd. INT. J. GERIAT. PSYCHIATRY. VOL. 12: 838±840 (1997)

PARTNERSHIP NURSING HOME CARE FOR DEMENTIA 839

Harwood, R. H. and Ebrahim, S. (1992) Is relocationharmful to institutionalised elderly people. Age Ageing21, 61±66.

Lyons, D., Cohen, M., Henderson, T. and Walker, N.(1995) Partnership nursing home care for dementia:

The Glasgow experience/the ®rst 12 weeks. Int. J.Geriatr. Psychiat. 10, 557±560.

McAuslane, L. and Sperlinger, D. (1994) The e�ects ofrelocation on elderly people with dementia and theirnursing sta�. Int. J. Geriatr. Psychiat. 9, 981±984.

INT. J. GERIAT. PSYCHIATRY. VOL. 12: 838±840 (1997) # 1997 John Wiley & Sons, Ltd.

840 D. LYONS, M. COHEN, T. HENDERSON AND N. WALKER