Systematic review: Effective characteristics of nursing homes and other residential long-term care settings for people with dementia

J Am Geriatr Soc. 2013 Aug;61(8):1399-409. doi: 10.1111/jgs.12372. Epub 2013 Jul 19.


Objectives: In response to the need for an evidence-based review of factors within long-term care settings that affect the quality of care, this review compared characteristics of nursing homes and other residential long-term care settings for people with dementia and their informal family caregivers with respect to health and psychosocial outcomes.

Design: Databases were searched for literature published between 1990 and March 2012 that met review criteria, including that at least 80% of the subject population had dementia.

Results: Fourteen articles meeting review criteria that were of at least fair quality were found: four prospective cohort studies, nine randomized controlled trials (RCTs), and one nonrandomized controlled trial. Overall, low or insufficient strength of evidence was found regarding the effect of most organizational characteristics, structures, and processes of care on health and psychosocial outcomes for people with dementia and no evidence for informal caregivers. Findings of moderate strength of evidence indicate that pleasant sensory stimulation reduces agitation for people with dementia. Also, although the strength of evidence is low, protocols for individualized care and to improve function result in better outcomes for these individuals. Finally, outcomes do not differ between nursing homes and residential care or assisted living settings for people with dementia except when medical care is indicated.

Conclusion: Given the paucity of high-quality studies in this area, additional research is needed to develop a sufficient evidence base to support consumer selection, practice, and policy regarding the best settings and characteristics of settings for residential long-term care of people with dementia.

Keywords: dementia; nursing homes; processes; residential care/assisted living; structures; systematic review.

Publication types

  • Comparative Study
  • Research Support, American Recovery and Reinvestment Act
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review
  • Systematic Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Alzheimer Disease / psychology
  • Alzheimer Disease / therapy*
  • Assisted Living Facilities*
  • Cohort Studies
  • Evidence-Based Practice / organization & administration
  • Homes for the Aged / organization & administration*
  • Humans
  • Long-Term Care / organization & administration*
  • Nursing Homes / organization & administration*
  • Prospective Studies
  • Psychomotor Agitation / psychology
  • Psychomotor Agitation / therapy
  • Quality Indicators, Health Care
  • Randomized Controlled Trials as Topic
  • Social Environment