Hostname: page-component-7c8c6479df-p566r Total loading time: 0 Render date: 2024-03-26T20:33:30.331Z Has data issue: false hasContentIssue false

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?

Published online by Cambridge University Press:  23 September 2013

Quincy M. Samus*
Affiliation:
Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Amrita Vavilikolanu
Affiliation:
Department of Epidemiology, Columbia University, New York, New York, USA
Lawrence Mayer
Affiliation:
Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Matthew McNabney
Affiliation:
Department of Medicine, Johns Hopkins Bayview, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Jason Brandt
Affiliation:
Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Constantine G. Lyketsos
Affiliation:
Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Adam Rosenblatt
Affiliation:
Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
*
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: qmiles@jhmi.edu.

Abstract

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.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexopoulos, G., Abrams, R., Young, R. and Shamoian, C. (1988). Use of Cornell scale in nondemented patients. Journal of the American Geriatric Society, 36, 230236.CrossRefGoogle ScholarPubMed
American Association of Homes and Services for the Aging, American Seniors Housing Association, Assisted Living Foundation of America, National Center for Assisted Living, National Investment Center for the Seniors Housing & Care Industry. (2009). Overview of Assisted Living (Facts and Trends).Google Scholar
American Psychological Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC: American Psychiatric Press.Google Scholar
Burdick, D. J.et al. (2005). Predictors of functional impairment in residents of assisted-living facilities: the Maryland-Assisted Living Study. Journal of Gerontology A: Biological Sciences and Medical Sciences, 60, 258264. doi: 10.1093/gerona/60.2.258.Google ScholarPubMed
Cummings, J., Mega, M., Gray, K., Rosenberg-hompson, S., Carusi, D. and Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 23082314.CrossRefGoogle ScholarPubMed
First, M. B., Spitzer, R. L., Gibbon, M. and Williams, J. B. W. (1995). Structured Clinical Interview for Axis I DSM-IV Disorders – Patient Edition (SCID-I/P). New York, NY: Biometrics Research Department, NY State Psychiatric Institute.Google Scholar
Folstein, M., Folstein, S. and McHugh, P. (1975). “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198. doi: 10.1016/0022-3956(75)90026-6.CrossRefGoogle ScholarPubMed
Hawes, C., Phillips, C. D. and Rose, M. (2000). High service or high privacy assisted living facilities, their residents and staff: results from a national survey. In Mollica, R. (ed.), State Assisted Living Policy, 1998 (Report HHS-100-94-0024; HHS-100-98-0013). Washington, DC: US Department of Health and Human Services, Rose Meyers Research Institute.Google Scholar
Lyketsos, C. G.et al. (1999). The General Medical Health Rating: a bedside global rating of medical comorbidity in patients with dementia. Journal of the American Geriatrics Society, 47, 487491.CrossRefGoogle ScholarPubMed
Lyketsos, C. G.et al. (2007). Effect of dementia and treatment of dementia on time to discharge from assisted living facilities: The Maryland-Assisted Living Study. Journal of the American Geriatrics Society, 55, 10311037. doi: 10.1111/j.15325415.2007.01225.xCrossRefGoogle ScholarPubMed
Magsi, H. and Malloy, T. (2005). Under-recognition of cognitive impairment in assisted living facilities. Journal of the American Geriatrics Society, 53, 295298. doi: 10.1111/j.1532-5415.2005.53117.x.CrossRefGoogle Scholar
Maust, D. T.et al. (2006). Predictors of caregiver unawareness and non-treatment of dementia among residents of assisted living facilities: The Maryland Assisted Living Study. American Journal of Geriatric Psychiatry, 14, 668675. doi: 10.1097/01.jgp.0000209214.28172.45.CrossRefGoogle Scholar
Mollica, R., Johnson-Lamarche, H. and O’Keeffe, J. (2005). State Residential Care and Assisted Living Policy: 2004. Available at: http://aspe.hhs.gov/daltcp/reports/2005/04alcom.htm; last accessed 3 September 2013.Google Scholar
National Center for Assisted Living. (2012). Assisted Living State Regulatory Review. Available at: http://www.ahcancal.org/ncal/resources/documents/final%2012%20reg%20review.pdf; last accessed 3 September 2013.Google Scholar
Rosenblatt, A.et al. (2004). The Maryland Assisted Living Study: pevalence, recognition, and treatment of dementia and other psychiatric disorders in the assisted living population of Central Maryland. Journal of the American Geriatrics Society, 52, 16181625. doi: 10.1111/j.1532-5415.2004.52452.x.CrossRefGoogle Scholar
Rosenblatt, A.et al. (2008). Acetylcholinesterase inhibitors in assisted living: patterns of use and association of retention. International Journal of Geriatric Psychiatry, 23, 178184. doi: 10.1002/gps.1859.CrossRefGoogle ScholarPubMed
Ruckdeschel, K. and Katz, I. (2004). Care of dementia and other mental disorders in assisted living facilities: new research and borrowed knowledge. Journal of the American Geriatrics Society, 52, 17711773. doi: 10.1111/j.1532-5415.2004.52476.x.CrossRefGoogle ScholarPubMed
Samus, Q. M.et al. (2005). The association of neuropsychiatric symptoms and environment with quality of life in assisted living residents with dementia. Gerontologist, 45 (Suppl. 1), 1926.CrossRefGoogle ScholarPubMed
Samus, Q. M.et al. (2009). Correlates of functional dependence among recently admitted assisted living residents with and without dementia. Journal of American Medical Directors Association, 10, 323329. doi: 10.1016/j.jamda.2009.01.004.CrossRefGoogle ScholarPubMed
Samus, Q. M.et al. (2013). 12-month incidence, prevalence, persistence and treatment of mental disorders among individuals recently admitted to assisted living facilities in Maryland. International Psychogeriatrics, 25, 721731. doi: 10.1017/S1041610212002244.CrossRefGoogle ScholarPubMed
Spillman, B. C. and Black, K. J. (2006). The Size and Characteristics of the Residential Care Population: Evidence from Three National Surveys. Washington, DC: US Department of Health and Human Services.Google Scholar
Teri, L.et al. (2010). Staff training in assisted living: evaluating treatment fidelity. American Journal of Geriatric Psychiatry, 18, 502509.CrossRefGoogle ScholarPubMed
Watson, L. C.et al. (2006). Depression in assisted living is common and related to physical burden. American Journal of Geriatric Psychiatry, 14, 876883.Google Scholar
Wilkinson, I. and Graham-White, J. (1980). Psychogeriatric Dependency Rating Scales (PGDRS): a method of assessment for use by nurses. British Journcal of Psychiatry, 137, 558565.CrossRefGoogle ScholarPubMed