International Psychogeriatrics

Research Article

Cohort differences in dementia recognition and treatment indicators among assisted living residents in Maryland: did a change in the resident assessment tool make a difference?

Quincy M. Samusa1 c1, Amrita Vavilikolanua2, Lawrence Mayera1, Matthew McNabneya3, Jason Brandta1, Constantine G. Lyketsosa1 and Adam Rosenblatta4

a1 Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

a2 Department of Epidemiology, Columbia University, New York, New York, USA

a3 Department of Medicine, Johns Hopkins Bayview, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

a4 Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA


Background: There is a lack of empirical evidence about the impact of regulations on dementia care quality in assisted living (AL). We examined cohort differences in dementia recognition and treatment indicators between two cohorts of AL residents with dementia, evaluated prior to and following a dementia-related policy modification to more adequately assess memory and behavioral problems.

Methods: Cross-sectional comparison of two AL resident cohorts was done (Cohort 1 [evaluated 2001–2003] and Cohort 2 [evaluated 2004–2006]) from the Maryland Assisted Living studies. Initial in-person evaluations of residents with dementia (n = 248) were performed from a random sample of 28 AL facilities in Maryland (physician examination, clinical characteristics, and staff and family recognition of dementia included). Adequacy of dementia workup and treatment was rated by an expert consensus panel.

Results: Staff recognition of dementia was better in Cohort 1 than in Cohort 2 (77% vs. 63%, p = 0.011), with no significant differences in family recognition (86% vs. 85%, p = 0.680), or complete treatment ratings (52% vs. 64%, p = 0.060). In adjusted logistic regression, cognitive impairment and neuropsychiatric symptoms correlated with staff recognition; and cognitive impairment correlated with family recognition. Increased age and cognitive impairment reduced odds of having a complete dementia workup. Odds of having complete dementia treatment was reduced by age and having more depressive symptoms. Cohort was not predictive of dementia recognition or treatment indicators in adjusted models.

Conclusions: We noted few cohort differences in dementia care indicators after accounting for covariates, and concluded that rates of dementia recognition and treatment did not appear to change much organically following the policy modifications.

(Received April 26 2013)

(Reviewed June 10 2013)

(Revised August 13 2013)

(Accepted August 19 2013)

(Online publication September 23 2013)

Key words:

  • aged care;
  • epidemiology;
  • clinical assessment;
  • dementia;
  • long-term care


c1 Correspondence should be addressed to: Dr. Quincy M. Samus, PhD, MS, Assistant Professor of Psychiatry, The Johns Hopkins School of Medicine, 5300 Alpha Commons Drive, 4th Floor, Baltimore, MD 21224, USA. Phone: +1-410-550-6744. Email: