Assisted living (AL) is a rapidly growing type of residence for the elderly, with approximately 1.3 million seniors as residents, and with an expected two-fold increase in occupancy over the next 10-15 years. Preliminary data presented here suggest that the elderly in AL have high rates of psychiatric disorders, with dementia being the most common. These conditions probably contribute to significant morbidity (such as functional impairments and caregiver burden), and to early discharge from AL, typically to a nursing home. Dementia and other psychiatric disorders are probably under-recognized and under-treated in AL, in part because of inadequate preparation of the AL care system to address them. There has never been a comprehensive study of dementia or of other psychiatric disorders in AL This study will gather information about the prevalence, detection, and treatment of dementia and other psychiatric disorders in AL residents. It will study a stratified, random sample of 275 AL residents in Maryland (100 from large facilities, 100 from small facilities and 75 from dementia special care units). Each resident will undergo a comprehensive evaluation for dementia and a standardized psychiatric diagnostic examination. S/he will also be rated on standardized scales quantifying dementia-associated behavioral disturbances, seriousness of general medical co-morbidity, severity of functional (IADL and ADL) impairments and caregiver burden. This will produce an estimate of the prevalence and morbidity associated with dementia in AL residents (Aim 1). It will also generate an estimate of the prevalence and morbidity associated with other psychiatric disorders, especially mood and anxiety disorders (Aim 2). Patient evaluations, chart reviews and interviews with family and professional caregivers will determine whether dementia or other psychiatric disorders are detected, or treated and how this affects clinical outcomes in assisted living (Aim 3). Study findings will likely have a substantial public health impact in gerontology, geriatric medicine and geriatric psychiatry. They will provide essential information about the prevalence and consequences of psychiatric morbidity among assisted living residents (projected to approach 3.9 million by 2025). This information is of great interest to healthcare providers, licensing agencies, policy makers, the assisted living industry and the general public. It is likely to 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 delay their discharge from assisted living facilities to nursing homes.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH060626-02
Application #
6392677
Study Section
Special Emphasis Panel (ZRG1-SNEM-2 (01))
Program Officer
Colpe, Lisa J
Project Start
2000-09-25
Project End
2003-08-31
Budget Start
2001-09-01
Budget End
2003-08-31
Support Year
2
Fiscal Year
2001
Total Cost
$385,986
Indirect Cost
Name
Johns Hopkins University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
045911138
City
Baltimore
State
MD
Country
United States
Zip Code
21218
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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

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