Clinician Article

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

  • Zimmerman S
  • Anderson WL
  • Brode S
  • Jonas D
  • Lux L
  • Beeber AS, et al.
J Am Geriatr Soc. 2013 Aug;61(8):1399-409. doi: 10.1111/jgs.12372. Epub 2013 Jul 19. (Review)
PMID: 23869936
Read abstract Read evidence summary
  • Geriatrics
    Relevance - 6/7
    Newsworthiness - 6/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 5/7
    Newsworthiness - 4/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 5/7
    Newsworthiness - 4/7


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.

Clinical Comments

Family Medicine (FM)/General Practice (GP)

It is good to know that we don't know too much about these issues.


A nice article but more relevant to care home managers or doctors with very direct and regular contact and influence in individual care homes. Unclear how generalisable this is in the USA.


Probably, this is the most rigorously conducted review in the field. As a geriatrician working in the LTCF setting, I found it extremely insightful, particularly from a policy makers' standpoint. Its clinical impact, however, may be rather limited.

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