Cohort differences in dementia recognition and treatment indicators among assisted living residents in Maryland: did a change in the resident assessment tool make a difference?
BACKGROUND
There is a lack of empirical evidence about the impact of regulations on dementia care quality in assisted living (AL). We examined cohort differences in dementia recognition and treatment indicators between two cohorts of AL residents with dementia, evaluated prior to and following a dementia-related policy modification to more adequately assess memory and behavioral problems.


METHODS
Cross-sectional comparison of two AL resident cohorts was done (Cohort 1 [evaluated 2001-2003] and Cohort 2 [evaluated 2004-2006]) from the Maryland Assisted Living studies. Initial in-person evaluations of residents with dementia (n = 248) were performed from a random sample of 28 AL facilities in Maryland (physician examination, clinical characteristics, and staff and family recognition of dementia included). Adequacy of dementia workup and treatment was rated by an expert consensus panel.


RESULTS
Staff recognition of dementia was better in Cohort 1 than in Cohort 2 (77% vs. 63%, p = 0.011), with no significant differences in family recognition (86% vs. 85%, p = 0.680), or complete treatment ratings (52% vs. 64%, p = 0.060). In adjusted logistic regression, cognitive impairment and neuropsychiatric symptoms correlated with staff recognition; and cognitive impairment correlated with family recognition. Increased age and cognitive impairment reduced odds of having a complete dementia workup. Odds of having complete dementia treatment was reduced by age and having more depressive symptoms. Cohort was not predictive of dementia recognition or treatment indicators in adjusted models.


CONCLUSIONS
We noted few cohort differences in dementia care indicators after accounting for covariates, and concluded that rates of dementia recognition and treatment did not appear to change much organically following the policy modifications.
Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Quincy M
QM
Samus
Amrita
A
Vavilikolanu
Lawrence
L
Mayer
Matthew
M
McNabney
Jason
J
Brandt
Constantine G
CG
Lyketsos
Adam
A
Rosenblatt
D000369:Aged, 80 and over; D040561:Assisted Living Facilities / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D003072:Cognition Disorders / Q000175:diagnosis / Q000628:therapy; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003704:Dementia / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006291:Health Policy / Q000331:legislation & jurisprudence; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D009483:Neuropsychological Tests