Residential care and senile dementia : the effect of the physical and social environment of homes for elderly people on residents suffering from senile dementia

Projected changes in the population structure are such that there is little doubt that the condition of senile dementia will present a major problem for the "carers", be they professional or "informal", in the coming decades. This problem has to be put in the context of a growing emphasis on caring for elderly mentally infirm people "in the community" rather than in hospitals. It is likely, therefore, that there will be an increased need for, and pressure on, residential care services. In the residential care of demented elderly people the major policy issues are: the use of specialist facilities, staffing, the role of the home as a community resource, building design, and, increasingly, performance review and monitoring. The study used a model based on the social ecology of aging to examine how these, and other environmental influences impact upon the demented elderly residents of the homes. The study was limited in scale and any conclusions drawn must be tentative, therefore. However, the results confirm some of the current trends in residential care policy and cast doubt upon others. On balance the evidence is in favour of the use of specialist facilities, although the wide variety of provision under this label needs to be recognised and the formation of "positive" regimes encouraged Recommendations to enhance the status of residential care staff are supported by the results of the study and there would appear to be a future in the development of in-service training which could build on the strengths and mitigate the weaknesses of backgrounds in nursing qualifications. The use of homes as resource centres for the communities in which they are based, needs careful consideration. While any policy which encourages visitors to keep up regular contact is likely to have a beneficial effect on residents, the provision of short-term respite care in long-term facilities is brought into question by the results of this study. The trend towards group-living units would appear to benefit the spatial orientation of residents. The study provides a starting point for effective monitoring of residential care by linking a number of indicators of "process", such as regime type, to outcomes for residents with senile dementia.