title: 12-month incidence, prevalence, persistence, and treatment of mental disorders among individuals recently admitted to assisted living facilities in Maryland.
abstract: BACKGROUND
  To estimate the 12-month incidence, prevalence, and persistence of mental disorders among recently admitted assisted living (AL) residents and to describe the recognition and treatment of these disorders.
  
  
  METHODS
  Two hundred recently admitted AL residents in 21 randomly selected AL facilities in Maryland received comprehensive physician-based cognitive and neuropsychiatric evaluations at baseline and 12 months later. An expert consensus panel adjudicated psychiatric diagnoses (using DSM-IV-TR criteria) and completeness of workup and treatment. Incidence, prevalence, and persistence were derived from the panel's assessment. Family and direct care staff recognition of mental disorders was also assessed.
  
  
  RESULTS
  At baseline, three-quarters suffered from a cognitive disorder (56% dementia, 19% Cognitive Disorders Not Otherwise Specified) and 15% from an active non-cognitive mental disorder. Twelve-month incidence rates for dementia and non-cognitive psychiatric disorders were 17% and 3% respectively, and persistence rates were 89% and 41% respectively. Staff recognition rates for persistent dementias increased over the 12-month period but 25% of cases were still unrecognized at 12 months. Treatment was complete at 12 months for 71% of persistent dementia cases and 43% of persistent non-cognitive psychiatric disorder cases.
  
  
  CONCLUSIONS
  Individuals recently admitted to AL are at high risk for having or developing mental disorders and a high proportion of cases, both persistent and incident, go unrecognized or untreated. Routine dementia and psychiatric screening and reassessment should be considered a standard care practice. Further study is needed to determine the longitudinal impact of psychiatric care on resident outcomes and use of facility resources.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. qmiles@jhmi.edu
authors.forename: Quincy M
authors.initials: QM
authors.lastname: Samus
authors.forename: Chiadi U
authors.initials: CU
authors.lastname: Onyike
authors.forename: Deirdre
authors.initials: D
authors.lastname: Johnston
authors.forename: Lawrence
authors.initials: L
authors.lastname: Mayer
authors.forename: Matthew
authors.initials: M
authors.lastname: McNabney
authors.forename: Alva S
authors.initials: AS
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
authors.forename: Adam
authors.initials: A
authors.lastname: Rosenblatt
mesh_terms: D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000627:therapeutic use; D040561:Assisted Living Facilities; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D003704:Dementia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D015577:Geriatric Assessment; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008396:Maryland / Q000453:epidemiology; D001523:Mental Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D015995:Prevalence; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents; D002800:Cholinesterase Inhibitors; D011619:Psychotropic Drugs