Impact of care settings on residents' functional and psychosocial status, physical activity and adverse events.

BACKGROUND: Internationally, as the number of older adults increases, different types of care settings are evolving to address the care needs of this growing group of individuals. AIMS AND
OBJECTIVES: The purpose of this study was to describe and compare clinical outcomes of residents with moderate to severe cognitive impairment living in residential care facilities (RCFs) and nursing homes (NHs).
DESIGN: This was a secondary data analysis that included data from two studies testing a Function-Focused Care for Cognitively Impaired (FFC-CI) Intervention.
METHODS: A total of 96 participants were from RCFs and 103 were from NHs. Change scores over a 6-month period in RCF and NH residents were evaluated using a multivariate analysis of variance.
RESULTS: Residential care facilities residents had more agitation, better function and engaged in approximately twice as much physical activity as those in NH settings at baseline. Controlling for treatment status and baseline differences, over 6 months, RCF residents showed a decrease of -22.77 ± 41.47 kilocalories used in 24 hours while those in NHs increased to a mean of 10.49 ± 33.65 kilocalories used. With regard to function, residents in RCFs declined 10.97 ± 18.35 points on the Barthel Index, while those in NHs increased 10.18 ± 19.56 points.
CONCLUSIONS: In this sample, NH residents were more likely to be African American, had more comorbidities, less cognitive impairment, engaged in less physical activity, were more impaired functionally and had less agitation than those in RCFs. Controlling for treatment group status and baseline differences in comorbidities, cognitive status and race, residents in RCFs declined more in terms of functional and physical activity over a 6-month period. IMPLICATIONS FOR PRACTICE: Ongoing research and clinical work is needed to understand the impact of care settings on clinical outcomes.