title: The impact of complex chronic diseases on care utilization among assisted living residents.
abstract: OBJECTIVE
  Many residents of assisted living (AL) have chronic diseases that are difficult to manage, including congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM). We estimated the amount and intensity of care delivered by the staff for residents with these conditions.
  
  
  METHODS
  We performed a secondary data analysis from the Maryland Assisted Living (MDAL) Study (399 residents, 29 facilities). In-person assessments included measures of cognition, function, depression, and general medical health. Diagnosis of CHF, COPD, and DM, as well as current medications was abstracted from AL medical charts. Measures of care utilization were operationalized at the resident level as: 1) minutes per day of direct care (caregiver activity scale [CAS]), 2) subjective staff ratings of care burden, and 3) assigned AL "level of care" (based on state regulatory criteria).
  
  
  RESULTS
  In best fit regression models, CHF and DM were not significant predictors of the evaluated care utilization measures; however, COPD was independently associated with increased minutes per day of direct care - 34% of the variance in the caregiver activity scale was explained by degree of functional dependency, cognitive impairment, age, and presence of COPD. Functional dependency, depressive symptoms, and age explained almost a quarter (23%) of the variance of staff care burden rating. For the AL level of care intensity rating, degree of functional dependency, level of cognition, and age were significant correlates, together explaining about 28% of the variance.
  
  
  CONCLUSIONS
  The presence of COPD was a significant predictor of time per day of direct care. However, CHF and DM were not correlates of care utilization measures. Functional and cognitive impairment was associated with measures of care utilization, reiterating the importance of these characteristics in the utilization and intensity of care consumed by AL residents. Further study of this population could reveal other forms and amounts of care utilization.
authors.affiliation: Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, 5200 Eastern Ave., MFL Bldg, 7th floor, Baltimore, MD 21224, USA. Electronic address: mmcnabne@jhmi.edu.
authors.forename: Matthew K
authors.initials: MK
authors.lastname: McNabney
authors.affiliation: Division of Geriatric Psychiatry, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Chiadi
authors.initials: C
authors.lastname: Onyike
authors.affiliation: Division of Geriatric Psychiatry, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Johnston
authors.affiliation: Division of Geriatric Psychiatry, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Mayer
authors.affiliation: Division of Geriatric Psychiatry, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Constantine
authors.initials: C
authors.lastname: Lyketsos
authors.affiliation: Division of Geriatric Psychiatry, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Brandt
authors.affiliation: Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Rosenblatt
authors.affiliation: Division of Geriatric Psychiatry, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Quincy
authors.initials: Q
authors.lastname: Samus
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities; D002908:Chronic Disease; D003920:Diabetes Mellitus / Q000628:therapy; D006296:Health Services / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D007297:Inpatients; D008396:Maryland; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy
keywords: Assisted living; Chronic diseases; care utilization