title: A comparison of small and large assisted living facilities for the diagnosis and care of dementia: the Maryland Assisted Living Study.
abstract: OBJECTIVE
  To compare the demographic, clinical, and psychiatric characteristics of residents living in small (< or = 15 beds) and large assisted living (AL) facilities in the United States.
  
  
  METHODS
  One hundred and ninety-eight residents in 10 large and 12 small assisted living facilities were comprehensively assessed as part of the Maryland Assisted Living Study (MD-AL). The presence or absence of dementia and psychiatric disturbances and the facilities' recognition and management of these disorders were compared across the two types of AL. Aspects of care delivery were also compared.
  
  
  RESULTS
  Small facilities had a higher prevalence of dementia (81%) compared to larger facilities (63%) and the mean Mini-Mental State Examination (MMSE) across all residents in small facilities (mean 13.04) was than in large facilities (mean 19.93)(p = 0.000). Almost all (98%) of the residents of small homes carried a diagnosis of a dementia or other psychiatric diagnosis, compared to 74% of residents in large facilities (p < 0.001). Psychosis in particular was more prevalent in the smaller homes and the mean Neuropsychiatric Inventory score, a measure of neuropsychiatric symptoms, was higher compared to large homes. Falls were more common in larger homes despite a greater number of personal care hours per week. The use of safety devices and restraints was significantly less common in large facilities compared to smaller homes, where 'geri-chair' and bedrails were more often used.
  
  
  CONCLUSIONS
  Rates of dementia and psychiatric disorder differ in assisted living facilities depending on size of facility.
authors.affiliation: Manchester Mental Health and Social Care Trust, University of Manchester, Department of Psychiatry and Behavioural Sciences, Mancheter, UK. Ileroi2002@yahoo.co.uk
authors.forename: Iracema
authors.initials: I
authors.lastname: Leroi
authors.forename: Quincy M
authors.initials: QM
authors.lastname: Samus
authors.forename: Adam
authors.initials: A
authors.lastname: Rosenblatt
authors.forename: Chiadi U
authors.initials: CU
authors.lastname: Onyike
authors.forename: Jason
authors.initials: J
authors.lastname: Brandt
authors.forename: Alva S
authors.initials: AS
authors.lastname: Baker
authors.forename: Peter
authors.initials: P
authors.lastname: Rabins
authors.forename: Constantine
authors.initials: C
authors.lastname: Lyketsos
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities / Q000592:standards*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D003704:Dementia / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006306:Health Surveys; D006742:Hospital Bed Capacity; D006801:Humans; D008297:Male; D008396:Maryland; D015995:Prevalence; D011482:Protective Devices / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D012656:Self-Help Devices / Q000706:statistics & numerical data