Freedom of movement and health of nursing home residents with dementia: an exploratory cross-sectional study.

Background: Having more freedom of movement may relate to better health in nursing home (NH) residents with dementia. Research that tests whether residents in NHs with more freedom of movement are healthier compared to residents in closed NHs is scarce. Also, existing research on freedom of movement does not consider the diverse dimensions of health. This study explored health differences between two groups of nursing home residents with dementia with different levels of freedom of movement.

Methods: We used a quantitative cross-sectional design to investigate differences in health between two groups of NH residents with dementia. One group lived in closed NHs (i.e., with closed unit doors) and the other group in semi-open NHs (i.e., with closed NH entrance doors). A total of 124 residents with dementia were recruited from five NHs in the Netherlands, of whom 61 residents lived in semi-open NHs and 63 residents lived in closed NHs. Data were collected using questionnaires to cover health dimensions according to the concept of Positive Health, including quality of life and participation, mental functioning and perception, daily functioning and bodily functions. An analysis of covariance, adjusted for age, gender and type of dementia, was used to examine differences in residents' health.

Results: Most included residents had Alzheimer's or vascular dementia and 68% were female. No significant demographic differences were observed between the two groups in age, gender, type of dementia, length of stay, length of diagnoses and type of care package (p-values ranged from 0.097 to 0.606). After adjusting for multiple comparisons, there were no significant differences in any of the assessed health dimensions between residents of semi-open nursing homes and those of closed nursing homes, with a significance threshold of p <.004 accounting for the correction for multiple testing (p-values ranged from 0.020 to 0.870).

Conclusions: This exploratory study found no significant differences in health between residents with dementia in semi-open and closed NHs. These findings contradict earlier research suggesting that more freedom of movement may enhance overall health in this population. Further research, preferably employing longitudinal designs, is necessary to establish causal pathways and identify the underlying mechanisms.