Identification and assessment of effective services and interventions: the nursing home perspective

In the past decade, researchers across the world have published a great number of studies on the care of nursing home residents with dementia. Investigations have concentrated on such important subjects as special care units, staff training, functional performance, and problem behaviors. However, most of the studies have lacked the rigor needed to establish the treatments that they tested as standards of care, according to criteria from the American Academy of Neurology. Without a solid scientific foundation, researchers in the USA have found it difficult to offer authoritative advice to policy makers and advocacy groups. This article will discuss some theoretical and methodological issues of research that require attention to fortify the scientific foundation. Topics include theoretical and definitional inconsistencies, sampling issues, limitations related to data collectors, the need for greater specificity of interventions, and outcome measures. The article will continue with an overview of areas that need further refinement and development. It will focus on combining basic and clinical sciences, combining behavioral and pharmacological research, combining clinical and health services research, reconceptualizing meaningful activity, palliative care in advanced dementia, certified nursing assistant training issues, and family training issues. The article will conclude with recommendations to establish collaborative research enterprises among existing organizations in the USA.