How Long-Term Care Quality Measures Address Alzheimer's Disease and Related Dementias in European Countries

Michael Lepore*, Franziska Zuniga, Jos M. G. A. Schols, Klaus Wingenfeld, Theo van Achterberg, Briana Murray

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objectives: Alzheimer's disease and related dementias (ADRD) are prevalent conditions in long-term care homes (LTCHs) with most LTCH residents living with ADRD in many countries. Despite the prevalence of ADRD in LTCHs, a recent examination of LTCH quality measurement programs in 4 countries revealed few LTCH quality measures addressed ADRD, most commonly as a risk adjuster. We sought to better understand how quality measurement programs address ADRD internationally. Design: International comparative analysis. Setting and Participants: We examined LTCH quality measures in 4 European countries—Germany, Switzerland, Belgium, and the Netherlands. Methods: The specifications to calculate each measure were assessed to determine whether the measure was calculated without assessing for ADRD, included only residents with ADRD, excluded residents with ADRD, or was risk adjusted for the presence of ADRD among the LTCH residents. Results: A total of 143 measures were examined across 4 quality measurement programs. Thirty-seven percent of the measures explicitly address ADRD. The programs addressed ADRD in starkly different ways. In Germany, most (13 of 15) measures addressed ADRD, and did so as an exclusion or inclusion criterion, and in Switzerland all the measures addressed ADRD through risk adjustment. In Flanders, Belgium, all measures were calculated without assessing for ADRD. In the Netherlands, one-third of the measures explicitly addressed ADRD by restricting the measure to psychogeriatric units. Conclusions and Implications: Although limited to examining measures from LTCH quality measurement programs in 4 European countries, this study adds evidence that ADRD tends not to be addressed by LTCH quality measures, but when ADRD is addressed, it tends to be through inclusion or exclusion criteria. LTCH regulators, policymakers, and providers can use this information to assess options for addressing ADRD in quality measurement programs. Future research is needed to assess how standard indicators of ADRD care quality differ across quality measurement programs.

Original languageEnglish
Pages (from-to)729-734
Number of pages6
JournalJournal of the American Medical Directors Association
Issue number5
Publication statusPublished - 1 May 2023


  • Dementia
  • quality measurement
  • long-term care
  • public reporting


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