The parent study is examining the use of antipsychotic and other psychotropic medications to address behavioral and psychological symptoms of assisted living (AL) residents with dementia, as well as correlates of medication use. Data collected to date indicate that 27% of residents with dementia are prescribed (typically contraindicated) antipsychotic medication; perhaps even more concerning, analyses find that medical and mental health care ?unexplored territory in AL -- relate to prescribing in an unexpected manner. Medical care. There has been concern that medical oversight is inadequate in AL, and strong advocacy for more on-site medical presence. When we began the parent study, we saw this issue looming on the horizon, and included four questions on medical care provision to examine the relationship of care to prescribing. Analyses from our first 169 AL communities indicate that on average, 12 different medical care providers treat residents in a given AL community,45% of residents receive care from a new provider (i.e., not the same provider as before they moved in), and 67% of providers do not visit the community to provide care. More so, the fewer the overall number of providers, and the more who provide care in the community, the higher the prescribing (p=.058 and .003 respectively). Mental health care. The lack of mental health care in nursing homes has long been criticized, and despite notable need there is little reason to expect it is more common in AL. That said, there is virtually no information about mental health care in AL, other than one question in our parent project about mental health consultations and care visits provided by a psychiatrist, psychologist, clinical social worker, or other mental health professional. Preliminary data tell an unexpected story: 92% of AL administrators report that one or more of their residents have received mental health care, and 70% report it is received on-site. Further, 20% report that mental health care is provided to at least half of their residents ? numbers dramatically higher than in nursing homes. More so, the more the residents who receive mental health care, the higher the prescribing of antipsychotic medications (p=.016). Together, these preliminary data call into question why more and closer care relate to more prescribing. It could be because such care improves detection and treatment, but given a 27% prescribing rate, there is cause for concern about the nature of the care. For example, it is possible that prescribing is in part responsive to staff reactivity, and/or that medical and mental health providers are not promoting the use of nonpharmacological practices to treat behavioral and psychological symptoms of dementia. The proposed supplement will interview administrators of all 245 AL communities in the parent study, and up to four medical and mental health care providers in each, to fully examine care and its relationship to prescribing.
Data indicate that as many as 27% of assisted living residents with dementia receive antipsychotics to address behavioral and psychological symptoms of dementia, despite the fact that these medications are strongly discouraged due to side effects. Emerging data indicate that prescribing is more likely when more medical and mental health care is provided to residents on-site, suggesting that new models of care are having an unintended effect. In response, this project will describe medical and mental health care provision in assisted living, develop typologies of that care, examine correlates of that care, and better determine how care provision relates to the prescribing of antipsychotic and other psychotropic medications in assisted living.
| Scales, Kezia; Zimmerman, Sheryl; Miller, Stephanie J (2018) Evidence-Based Nonpharmacological Practices to Address Behavioral and Psychological Symptoms of Dementia. Gerontologist 58:S88-S102 |
| Prizer, Lindsay P; Zimmerman, Sheryl (2018) Progressive Support for Activities of Daily Living for Persons Living With Dementia. Gerontologist 58:S74-S87 |
