title: Predictors of caregiver unawareness and nontreatment of dementia among residents of assisted living facilities: the Maryland Assisted Living Study.
abstract: OBJECTIVE
  Assisted living (AL) is a rapidly expanding residential option for the senior population. With increased utilization, it becomes important to understand the detection and treatment of dementia in this setting, but little is known. The objective of this study was to identify and evaluate factors associated with caregiver unawareness of dementia and failure to treat dementia in AL.
  
  
  METHODS
  The setting was a cross-sectional study of a random sample of AL facilities in central Maryland (The Maryland Assisted Living Study). Geriatric psychiatrists evaluated 198 participants and assigned dementia diagnoses to 134 residents (67.7%). The extent to which dementia was recognized and treated in these facilities was estimated on the basis of caregiver interview and chart review data. Using logistic regression models, demographic, cognitive, and functional measures were evaluated as predictors of caregiver unawareness and nontreatment of dementia.
  
  
  RESULTS
  Severity of cognitive and functional impairment, number of neuropsychiatric symptoms, and male gender were all independent predictors of caregiver unawareness of dementia. Family and caregiver unawareness of dementia and female gender were predictors of failure to treat dementia. Detection and treatment were not associated with race, age, or overall medical health.
  
  
  CONCLUSIONS
  Caregivers were more likely to be unaware of dementia in residents who did not have severe cognitive impairment or obvious behavioral and functional problems. Caregiver and family unawareness were in turn associated with nontreatment. Observed gender differences in detection and treatment will require replication and further study. These observations suggest that systematic educational interventions for caregivers and families may improve detection and hence treatment in the AL setting.
authors.affiliation: Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
authors.forename: Donovan T
authors.initials: DT
authors.lastname: Maust
authors.forename: Chiadi U
authors.initials: CU
authors.lastname: Onyike
authors.forename: Jeannie-Marie E
authors.initials: JM
authors.lastname: Sheppard
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Mayer
authors.forename: Quincy M
authors.initials: QM
authors.lastname: Samus
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
authors.forename: Adam
authors.initials: A
authors.lastname: Rosenblatt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities; D001364:Awareness; D017028:Caregivers; D003430:Cross-Sectional Studies; D003704:Dementia / Q000175:diagnosis / Q000451:nursing* / Q000628:therapy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D008396:Maryland; D015999:Multivariate Analysis; D009740:Nursing Staff