Differences in Case Conferences in Dementia Specific vs Traditional Care Units in German Nursing Homes: Results from a Cross-Sectional Study

Published:September 29, 2015DOI:



      To investigate differences in the provision and performance of case conferences for people with dementia between dementia special care units (DSCUs) and traditional care units (TCUs) in nursing homes. Because DSCUs employ more staff, we expect the likelihood of the provision of case conferences to be higher in DSCUs.


      Observational cross-sectional study. Residents from DSCUs and TCUs were compared using genetic propensity score matching over all of the observed potential covariates, including the characteristics that served as admission criteria for DSCUs. Because of the multisite structure of the data, clustering was accounted for with a generalized mixed model.


      DSCUs are defined as units within nursing homes that offer care exclusively to residents with dementia and that charge higher rates for the specialized care provided. TCUs are defined as care units for residents with and without dementia.


      A matched sample was drawn out of a convenience sample of 1808 residents from 51 nursing homes. It consisted of 264 residents from 16 DSCUs and 264 residents from 48 TCUs.




      Data regarding the provision of case conferences were collected by the nurses using the Dementia Care Questionnaire. Other collected data included challenging behavior (Neuropsychiatric Inventory Questionnaire), mobility (Physical Self-Maintenance Scale), cognitive impairment (Dementia Screening Scale), and sociodemographic information.


      In the DSCU group, case conferences were provided to 91% (n = 224) of the residents; in the TCU group, 82.5% (n = 203) received a case conference. After adjusting for clustering, no significant difference between DSCUs and non-DSCUs was found. The topic “challenging behaviors” was discussed more often in case conferences in TCUs.


      Case conferences are a widespread intervention in German nursing homes, including both DSCUs and TCUs. The provision of a case conference is not a special feature of DSCUs.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Alzheimer's Association
        2013 Alzheimer's disease facts and figures.
        Alzheimer Dement. 2013; 9: 208-248
        • Pot A.M.
        • Petrea I.
        Bupa/ADI report: Improving dementia care worldwide: Ideas and advice on developing and implementing a National Dementia Plan.
        BUPA/ADI, London2013
        • Crespo M.
        • Hornillos C.
        • Gomez M.M.
        Dementia special care units: A comparison with standard units regarding residents' profile and care features.
        Int Psychogeriatr. 2013; 25: 2023-2031
        • Zuidema S.U.
        • de Jonghe J.F.
        • Verhey F.R.
        • et al.
        Environmental correlates of neuropsychiatric symptoms in nursing home patients with dementia.
        Int J Geriatr Psychiatry. 2010; 25: 14-22
        • Weyerer S.
        • Schäufele M.
        • Hendlmeier I.
        Evaluation of special and traditional dementia care in nursing homes: Results from a cross-sectional study in Germany.
        Int J Geriatr Psychiatry. 2010; 25: 1159-1167
        • Park-Lee E.
        • Sengupta M.
        • Harris-Kojetin L.D.
        Dementia Special Care Units in Residential Care Communities: United States, 2010.
        NCHS Data Brief No. 134, Hyattsville2013
        • Palm R.
        • Bartholomeyczik S.
        • Roes M.
        • et al.
        Structural characteristics of specialised living units for people with dementia: A cross-sectional study in German nursing homes.
        Int J Ment Health Syst. 2014; 8: 39
        • Maslow K.O.
        Review of a decade of dementia special care unit research: Lessons learned and future directions.
        Alzheimer Care Q. 2001; 2: 10-16
        • Phillips C.D.
        • Spry K.M.
        • Sloane P.D.
        • et al.
        Use of physical restraints and psychotropic medications in Alzheimer special care units in nursing homes.
        Am J Public Health. 2000; 90: 92-96
        • Gruneir A.
        • Lapane K.L.
        • Miller S.C.
        • et al.
        Is dementia special care really special? A new look at an old question.
        J Am Geriatr Soc. 2008; 56: 199-205
        • Kok J.S.
        • Berg I.J.
        • Scherder E.J.
        Special care units and traditional care in dementia: Relationship with behavior, cognition, functional status and quality of life—A review.
        Dement Geriatr Cogn Dis Extra. 2013; 3: 360-375
      1. Stadt Hamburg. Vereinbarung über die besondere stationäre Dementenbetreuung in Hamburg. Hamburg: 2012 [updated 01.10.2012]. Available at: Accessed August 17, 2015.

      2. Carpenter I, Hirdes JP. Using inter RAI assessment systems to measure and maintain quality of long-term care. OECD Health Policy Studies: OECD Publishing; 2013. Available at: Accessed August 17, 2013.

        • Reuther S.
        • Dichter M.N.
        • Buscher I.
        • et al.
        Case conferences as interventions dealing with the challenging behavior of people with dementia in nursing homes: A systematic review.
        Int Psychogeriatr. 2012; 24: 1891-1903
        • Phillips J.L.
        • West P.A.
        • Davidson P.M.
        • et al.
        Does case conferencing for people with advanced dementia living in nursing homes improve care outcomes: Evidence from an integrative review?.
        Int J Nurs Stud. 2013; 50: 1122-1135
        • Holle D.
        • Kruger C.
        • Halek M.
        • et al.
        Experiences of nursing staff using dementia-specific case conferences in nursing homes.
        Am J Alzhiemers Dis Other Demen. 2015; 30: 228-237
        • Palm R.
        • Köhler K.
        • Schwab C.G.
        • et al.
        Longitudinal evaluation of dementia care in German nursing homes: The “DemenzMonitor” study protocol.
        BMC Geriatr. 2013; 13: 123
        • Köhler L.
        • Weyerer S.
        • Schäufele M.
        Proxy screening tools improve the recognition of dementia in old-age homes: Results of a validation study.
        Age Ageing. 2007; 36: 549-554
        • Palm R.
        • Köhler K.
        • Bartholomeyczik S.
        • et al.
        Assessing the application of non-pharmacological interventions for people with dementia in German nursing homes: Feasibility and content validity of the dementia care questionnaire (DemCare-Q).
        BMC Res Notes. 2014; 7: 950
        • Lawton P.M.
        • Brody E.M.
        Assessement of older people: Self-maintaining and instrumental activities of daily living.
        Gerontologist. 1969; 9: 179-186
        • Kaufer D.I.
        • Cummings J.L.
        • Ketchel P.
        • et al.
        Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory.
        J Neuropsychiatry Clin Neurosci. 2000; 12: 233-239
        • Rosenbaum P.R.
        • Rubin D.B.
        The central role of the propensity score in observational studies for causal effects.
        Biometrika. 1983; 70: 41-55
        • Diamond A.
        • Sekhon J.S.
        Genetic matching for estimating causal effects: A general multivariate matching method for achieving balance in observational studies.
        Rev Econ Stat. 2012; (Available at:) (Accessed August 17, 2015)
      3. R Core Team. R: A language and environment for statistical computing. Vienna, Austria: 2015. Available at: Accessed September 21, 2015.

        • Crotty M.
        • Halbert J.
        • Rowett D.
        • et al.
        An outreach geriatric medication advisory service in residential aged care: A randomised controlled trial of case conferencing.
        Age Ageing. 2004; 33: 612-617