Assisted Living (AL) has grown rapidly over the last 15 years, but little is known about the psychiatric morbidity of AL residents. This resubmission is a five-year continuation of the Maryland Assisted Living Study (1R01 MH60626). MD-AL was a two-year project intended to estimate the prevalence of dementia and psychiatric disorders in a stratified random sample of assisted living residents. By this time, that study has completed assessment of 150 residents, with anticipated final recruitment of 200. Participants undergo a comprehensive evaluation for dementia, a standardized psychiatric examination, and are rated on scales quantifying dementia-associated behavioral disturbances, general medical co-morbidity, functional (IADL and ADL) impairment, quality of life, and caregiver burden. Information is collected on the need for services. Basic data are collected on the AL facility, the resident's primary caregiver and a family informant. The study team has acquired critical experience and assembled a cohort of facilities and residents for further study. Our data provide the first direct estimate of psychiatric morbidity in AL: preliminary analyses indicate that 69% of AL residents suffer from dementia, with 28% suffering from another DSM-IV diagnosis, and cumulative prevalence of dementia or another psychiatric disorder of 81%. Analyses indicate that less than 1/2 of psychiatric morbidity in AL is appropriately detected and managed, and that this morbidity is associated with greater disability and worse life quality. Now the study team proposes to assess longitudinally the impact of dementia and other psychiatric morbidity on two key AL outcomes: quality of life and the ability to age in place. This will be accomplished by continued semi-annual in person follow-up of the original 200 study participants and by the recruitment of 200 more residents who have been admitted to AL in the last 3 months; residents will be followed to death or discharge from AL, or for up to three years. This will permit longitudinal study of the course, detection, and treatment of dementia and other psychiatric disorders in AL residents (Aim 1), the impact of dementia and other psychiatric morbidity, treated and untreated, on quality of life (Aim 2), and time to death or discharge from the facility (Aim 3). Study findings are expected to have a substantial impact in gerontology, geriatric medicine and geriatric psychiatry. They will provide essential information about the consequences of psychiatric morbidity on the ability of assisted living residents (projected to approach 3.9 million by 2025) to age in place. This information is of great interest to healthcare providers, licensing agencies, policy makers, the assisted living industry and the general public. Study findings may affect clinical practices in assisted living resulting in the implementation of assisted living-based screening and treatment programs for dementia and other psychiatric disorders that will benefit residents, and may improve quality of life, and delay discharge.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH060626-07
Application #
7245031
Study Section
Social Sciences, Nursing, Epidemiology and Methods 4 (SNEM)
Program Officer
Niederehe, George T
Project Start
1999-12-01
Project End
2009-06-30
Budget Start
2007-07-01
Budget End
2009-06-30
Support Year
7
Fiscal Year
2007
Total Cost
$750,007
Indirect Cost
Name
Johns Hopkins University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
McNabney, Matthew K; Onyike, Chiadi; Johnston, Deirdre et al. (2014) The impact of complex chronic diseases on care utilization among assisted living residents. Geriatr Nurs 35:26-30
de Medeiros, Kate; Rubinstein, Robert L; Onyike, Chiadi U et al. (2013) Childless Elders in Assisted Living: Findings from the Maryland Assisted Living Study. J Hous Elderly 27:206-220
Samus, Quincy M; Onyike, Chiadi U; Johnston, Deirdre et al. (2013) 12-month incidence, prevalence, persistence, and treatment of mental disorders among individuals recently admitted to assisted living facilities in Maryland. Int Psychogeriatr 25:721-31
Samus, Quincy M; Vavilikolanu, Amrita; Mayer, Lawrence et al. (2013) 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? Int Psychogeriatr 25:2047-56
Brandt, Jason; Bakker, Arnold; Maroof, David Aaron (2010) Auditory confrontation naming in Alzheimer's disease. Clin Neuropsychol 24:1326-38
Samus, Quincy M; Mayer, Lawrence; Onyike, Chiadi U et al. (2009) Correlates of functional dependence among recently admitted assisted living residents with and without dementia. J Am Med Dir Assoc 10:323-9
Black, Betty S; Brandt, Jason; Rabins, Peter V et al. (2008) Predictors of providing informed consent or assent for research participation in assisted living residents. Am J Geriatr Psychiatry 16:83-91
Samus, Quincy M; Mayer, Lawrence; Baker, Alva et al. (2008) Characteristics and outcomes for assisted living residents with dementia: comparing dementia-specific care units with non-dementia-specific care units. J Am Geriatr Soc 56:1361-3
Smith, Marianne; Samus, Quincy M; Steele, Cynthia et al. (2008) Anxiety symptoms among assisted living residents: implications of the ""no difference"" finding for participants with and without dementia. Res Gerontol Nurs 1:97-104
Onyike, Chiadi U (2008) Neuroleptic discontinuation during dementia care: a recent trial and its implications for practice. Nat Clin Pract Neurol 4:528-9

Showing the most recent 10 out of 25 publications