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J Am Geriatr Soc. 2006 Sep;54(9):1436-41.

Measuring physical and social environments in nursing homes for people with middle- to late-stage dementia.

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  • 1Department of Community Health Sciences, University of Calgary, Calgary, Canada.



To evaluate measures of dementia care environments by comparing a special care facility (SCF) with traditional institutional facilities (TIFs).


A cross-sectional comparative study of nursing home environments conducted as part of a longitudinal study on quality of life for residents with dementia.


Twenty-four traditional nursing homes and one special care facility.


One SCF with six distinct environments, 24 TIFs with 45 distinct environments, and 88 family members.


Therapeutic Environment Screening Scale-2+ (TESS-2+); Special Care Unit Environmental Quality Scale (SCUEQS), a subset of the TESS-2+ items; Composite Above Average Quality Score (CAAQS), a composite score of all items on the TESS-2+; and Models of Care Instrument (MOCI).


The SCUEQS did not detect a significant difference between the SCF and the TIFs (30.0 vs 27.2, P = .28). The CAAQS detected a significant difference between the SCF and the TIFs, whereby the SCF environments were rated as having above-average quality in 71.4% of the domains, compared with 57.3% for the TIF environments (95% confidence interval (CI) for difference = 2.6-25.6%, P = .02). Using the MOCI, SCF families were 1.8 times as likely to rate the SCF as a home or resort versus a hospital as TIF families rating TIFs (95% CI for odds ratio = 1.5-2.1, P < .001).


The TESS-2+ CAAQS differentiated between physical environments better than the more established SCUQES. The MOCI distinguished between environments using a more holistic approach to measurement. The availability of environmental measures that are able to discriminate between specialized and traditional long-term care settings will facilitate future outcome-based research.

[PubMed - indexed for MEDLINE]
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