Quality of life of residents with dementia in traditional versus small-scale long-term care settings: A quasi-experimental study

Background: The number of people living with dementia worldwide is increasing, resulting in a need for more residential care. In response to criticism of the traditional medical approach to residential dementia care, many large nursing homes are transforming their traditional care facilities into more home-like small-scale living facilities. Objectives: This study examined the assumed benefits of small-scale living for residents with dementia, compared to traditional long-term care in the Netherlands and Belgium. The primary outcome was quality of life, divided into nine different domains. Design: The study had a longitudinal design within a one-year time interval. Settings: Five long-term care settings in the Netherlands and Belgium containing four traditional and twelve small-scale living units participated in the study. Participants: Data were obtained from 179 residents with dementia (age > 65 years) (Dutch small-scale N = 51, traditional N = 51, Belgian small-scale N = 47, traditional N = 30). Methods: Nurses and nursing assistants were trained to fill in the questionnaires. Results: In the Dutch sample, residents in small-scale settings had higher mean scores on 'social relations', 'positive affect', and 'having something to do' than residents in traditional settings. Moreover, mean scores on 'caregiver relation' and 'negative affect' remained stable over time among residents in small-scale settings, but decreased in traditional settings. These differences could not be explained by differences in behavioural characteristics, behavioural interventions, or social interaction. In the Belgian sample, fewer differences were found between traditional and small-scale settings. Nevertheless, residents in small-scale settings were reported to experience less 'negative affect' than those in traditional settings, which could be explained by differences in depression. Over time, however, residents 'felt more at home' in traditional settings, whereas no such increase was found for small-scale settings. Moreover, the mean quality of life scores on 'restless behaviour', 'having something to do' and 'social relations' decreased in small-scale settings, but remained stable in traditional settings. Conclusions: Both small-scale and traditional settings appear to have beneficial effects on different domains of quality of life of residents with dementia. Future research should focus more on the quality and content of the care provided, than on the effects of the scale and design of the environment in long-term care settings.