title: Assisted living policies promoting autonomy and their relationship to resident depressive symptoms.
abstract: OBJECTIVE
  The objective of this study is to determine the relationship between facility policies regarding autonomy and depression among residents of residential care/assisted living (RC/AL) facilities.
  
  
  METHODS
  A stratified sample of RC/AL facilities in Florida, Maryland, New Jersey, and North Carolina participated in the study. Patient characteristics for individuals 65 years and older were obtained from medical record reviews and in-person interviews. Facility administrators provided data on facility characteristics. Data on 1,098 residents were used to examine the relationship between facility policies as measured by domains of the Policy and Program Information Form and resident depressive symptoms and its factors as measured by the Cornell Scale for Depression in Dementia. Generalized estimating equation regression analysis was used to examine this relationship and control for other explanatory variables and clustering.
  
  
  RESULTS
  Among the policy variables examined, only the degree to which residents were involved in facility administration was consistently associated with depressive symptoms. Greater resident influence over facility policies and involvement in facility administration was significantly associated with lower levels of depressive symptoms. Resident control over their daily activities, the facility's tolerance for disruptive behavior, and the extent to which facilities had formal mechanisms for defining expected behavior were not significantly associated with levels of depressive symptoms.
  
  
  CONCLUSIONS
  Although some facilities provide residents with opportunities to select activities or meal times, these policies were not associated with depressive symptoms. However, results are consistent with the hypothesis that resident involvement in facility administrative decision-making is associated with fewer depressive symptoms. Future research should explore the causal nature of this relationship and might provide guidance for policy and practice.
authors.affiliation: Carolina Program in Healthcare and Aging Research, The University of North Carolina, Chapel Hill, NC 27599-1030, USA. corychen@email.unc.edu
authors.forename: Cory K
authors.initials: CK
authors.lastname: Chen
authors.forename: Sheryl
authors.initials: S
authors.lastname: Zimmerman
authors.forename: Philip D
authors.initials: PD
authors.lastname: Sloane
authors.forename: Ann Louise
authors.initials: AL
authors.lastname: Barrick
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities / Q000458:organization & administration*; D003256:Community Participation; D003657:Decision Making; D003866:Depressive Disorder / Q000175:diagnosis*; D005260:Female; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration; D008297:Male; D009483:Neuropsychological Tests; D009657:North Carolina; D016134:Organizational Policy; D026684:Personal Autonomy; D013223:Statistics as Topic