Does Person-Centered Care Improve Outcomes for Residents with Depression and Dementia?

Members | August 07, 2015 | by Geralyn Magan

The LeadingAge Center for Applied Research is partnering with the Francis E. Parker Memorial Home to assess whether older adults with depression and/or dementia experience better outcomes when they live in nursing homes that implement person-centered care and follow a “household model.”

The LeadingAge Center for Applied Research (CFAR) is partnering with the Francis E. Parker Memorial Home to assess the effects of person-centered care on nursing home residents. Parker, a LeadingAge member in Piscataway, NJ, is funding the study.

The Parker Nursing Home Study will test whether older adults with depression and/or dementia experience better outcomes when they live in nursing homes that: 

  • Implement person-centered care. Person-centered care focuses on ensuring that residents’ needs and choices, not institutional convenience, govern daily life.
  • Follow a “household model.” The household model clusters a small number of residents’ rooms around a central kitchen, dining room and living room area, eliminating long hallways and “parking time” in wheelchairs. The layout is designed to permit staff members and residents to spend more quality time together. 

“Up to 85% of U.S. nursing homes have adopted some degree of person-centered care,” says Dr. Linda Hermer, CFAR’s senior research scientist, who is leading the study. “As person-centered care and the household model grow in popularity, it’s important to make sure the benefits justify the implementation costs.”

The Parker Nursing Home Study will take place at 3 nursing homes:

  • Parker at Monroe in Monroe Township, NJ, which features the household model and is the study’s “experimental” home.
  • Parker at River Road in Piscataway, NJ, which is a “control” home in the study. 
  • A second “control” home that is not associated with Parker.

STUDY QUESTIONS

Over the next 18 months, Hermer and her research team will examine whether person-centered care, implemented alone or in combination with the household model, results in any of the following outcomes:

  • Aides spending less time on institutional tasks and more time engaging in meaningful social interactions with residents.
  • Residents being more engaged in their activities and conversations.
  • Residents exhibiting fewer symptoms of depression.
  • The dementia of residents progressing more slowly.
  • Residents living longer, on average.

STUDY METHODOLOGY

More than 100 residents, 180 aides and 54 nurses at the 3 nursing homes will participate in the Parker Nursing Home Study.

Hermer and Parker staff worked to match participants from Parker at Monroe with participants from the 2 control homes. As a result, study participants living in all 3 nursing homes have similar characteristics, including their initial depression and/or dementia status, degree of mobility, major comorbidities, age range and gender.

Residents receiving hospice care, and residents with advanced dementia, were not included in the study.

Research assistants from the School of Public Health at Rutgers University will help Hermer with the study’s data collection tasks. Assistants will work onsite at the 3 nursing homes to observe a variety of interactions between participating residents and nurses or aides. The students will use laptop computers to score those interactions in 35 categories. The scoring process will use several scales, some of which were designed by Hermer. 

Observations will be recorded in 3 phases that will each last 3 months. The initial observation phase began in July and will last until September. A second phase will begin in the spring of 2016. The final phase of data collection will take place in the winter of 2016-2017.

“We will be coding the degree of person-centered care delivered by each aide and each nurse,” explains Hermer. “We will use all that information to evaluate the quality of social interactions that take place in the 3 homes. Then, we will correlate the amount and the degree of those interactions with any changes we find in residents’ depressive symptoms or the progression of dementia.”

Changes in residents’ depressive or dementia symptoms will be determined by reviewing residents’ medical records and comparing residents’ scores on standard tests, like the Mini-Mental Status Examination, which will be administered several times during the study period.

SHARING STUDY FINDINGS

CFAR will produce an issue brief at the end of the study and plans to publish its findings in peer-reviewed journals.

“With the Parker Nursing Home Study, we have the opportunity to validate a long-held belief that delivering person-centered care in a homelike environment can provide residents with optimal outcomes and quality of life,” says Gloria Zayanskosky, chief quality and community services officer at Parker Memorial Home. “We look forward to sharing the results with our colleagues in the field, so that we all might improve care and services for our elders.”