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Gerontol Geriatr Med. 2019 Jul 13;5:2333721419861198. doi: 10.1177/2333721419861198. eCollection 2019 Jan-Dec.

Assessing Quality for People Living With Dementia in Residential Long-Term Care: Trends and Challenges.

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Duke University School of Nursing, Durham, NC, USA.
Geriatric Research Education and Clinical Center, Durham Veterans Affairs Healthcare System, NC, USA.
City, University of London, UK.


The global prevalence of dementia is growing rapidly, driving an increased use of residential long-term care (LTC) services. Performance indicators for residential LTC should support targeting of limited resources to promote person-centered care, health, and well-being for both patients and caregivers (formal and informal), yet many performance indicators remain focused on structure, process, or outcome measures that are only assumed to support personally relevant outcomes for those with dementia, without direct evidence of meaningfulness for these individuals. In this article, two complementary approaches to assessing quality in residential LTC serve as a lens for examining a series of tensions related to assessment in this setting. These include measurement-focused approaches using generic psychometrically valid instruments, often used to monitor quality of services, and meaning-focused approaches using individual subjective assessment of personally relevant outcomes, often used to monitor care planning. Examples from the European and U.S. literature suggest an opportunity to strengthen an emphasis on personally meaning-focused outcomes in quality assessment.


Alzheimer’s/dementia; long-term care; outcomes; performance indicators; person-centered care

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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