title: Transition to nursing home from assisted living is not associated with dementia or dementia-related problem behaviors.
abstract: OBJECTIVE
  To examine risk factors for transition from assisted living (AL) care to skilled nursing facility (SNF) care in a random sample of adults residing in AL.
  
  
  METHODS
  Baseline clinical evaluation and telephone follow-up at 6-month intervals for up to 36 months.
  
  
  METHODS
  AL facilities in central Maryland.
  
  
  METHODS
  There were 198 participants randomly sampled from AL facilities stratified by facility size.
  
  
  METHODS
  Consensus diagnoses by multidisciplinary geriatric psychiatry team as well as a broad range of neuropsychiatric and functional scales including Neuropsychiatric Inventory, Cornell Scale for Depression in Dementia, Mini-Mental State Exam, and Alzheimer's Disease Related Quality of Life Scale, as well as cognitive tests. Possible risk factors for transition to SNF were assessed in Cox proportional-hazards multivariate regression methods, using a P value less than .05 for statistical significance.
  
  
  RESULTS
  Twenty-nine participants transitioned to SNF care. Mean AL survival time from baseline evaluation was 0.8 (SD 0.6) years for residents transitioned to SNF and 1.4 (SD 0.7) years for residents remaining in AL at follow-up. Risk factors for transition to SNF included declining health, chronic pain, appetite changes, and being widowed, while insomnia was protective against transition to SNF. Surprisingly, dementia and neuropsychiatric symptoms did not increase risk of transition to SNF.
  
  
  CONCLUSIONS
  Survival time in AL is determined by factors similar to those operating on community-dwelling elderly, but dementia and neuropsychiatric symptoms do not alter survival time.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, Osler 320, 600 North Wolfe Street, Baltimore, MD, USA. prosenb9@jhmi.edu
authors.forename: Paul B
authors.initials: PB
authors.lastname: Rosenberg
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Mielke
authors.forename: Quincy M
authors.initials: QM
authors.lastname: Samus
authors.forename: Adam
authors.initials: A
authors.lastname: Rosenblatt
authors.forename: Alva
authors.initials: A
authors.lastname: Baker
authors.forename: Jason
authors.initials: J
authors.lastname: Brandt
authors.forename: Peter V
authors.initials: PV
authors.lastname: Rabins
authors.forename: Constantine G
authors.initials: CG
authors.lastname: Lyketsos
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities / Q000706:statistics & numerical data*; D003704:Dementia / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D008609:Mental Status Schedule; D009483:Neuropsychological Tests; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010146:Pain / Q000209:etiology; D010360:Patient Transfer / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology; D016019:Survival Analysis