JAMDA
Volume 7, Issue 2 , Pages 73-78, February 2006

Transition to Nursing Home From Assisted Living Is not Associated With Dementia or Dementia-Related Problem Behaviors

  • Paul B. Rosenberg, MD

      Affiliations

    • Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, Baltimore, MD
    • Corresponding Author InformationAddress correspondence to Paul B. Rosenberg, MD, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Osler 320, 600 North Wolfe Street, Baltimore, MD 21287.
    • ,
  • Michelle M. Mielke, PhD

      Affiliations

    • Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, Baltimore, MD
    • ,
  • Quincy M. Samus, BA

      Affiliations

    • Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, Baltimore, MD
    • ,
  • Adam Rosenblatt, MD

      Affiliations

    • Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, Baltimore, MD
    • The Copper Ridge Institute, Sykesville, MD
    • ,
  • Alva Baker, MD

      Affiliations

    • The Copper Ridge Institute, Sykesville, MD
    • ,
  • Jason Brandt, PhD

      Affiliations

    • Division of Medical Psychology, Johns Hopkins School of Medicine, Baltimore, MD
    • The Copper Ridge Institute, Sykesville, MD
    • ,
  • Peter V. Rabins, MD

      Affiliations

    • Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, Baltimore, MD
    • ,
  • Constantine G. Lyketsos, MD, MHS

      Affiliations

    • Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, Baltimore, MD
    • The Copper Ridge Institute, Sykesville, MD

published online 08 August 2005.

Objectives

To examine risk factors for transition from assisted living (AL) care to skilled nursing facility (SNF) care in a random sample of adults residing in AL.

Design

Baseline clinical evaluation and telephone follow-up at 6-month intervals for up to 36 months.

Setting

AL facilities in central Maryland.

Participants

There were 198 participants randomly sampled from AL facilities stratified by facility size.

Measurements

Consensus diagnoses by multidisciplinary geriatric psychiatry team as well as a broad range of neuropsychiatric and functional scales including Neuropsychiatric Inventory, Cornell Scale for Depression in Dementia, Mini-Mental State Exam, and Alzheimer’s Disease Related Quality of Life Scale, as well as cognitive tests. Possible risk factors for transition to SNF were assessed in Cox proportional-hazards multivariate regression methods, using a P value less than .05 for statistical significance.

Results

Twenty-nine participants transitioned to SNF care. Mean AL survival time from baseline evaluation was 0.8 (SD 0.6) years for residents transitioned to SNF and 1.4 (SD 0.7) years for residents remaining in AL at follow-up. Risk factors for transition to SNF included declining health, chronic pain, appetite changes, and being widowed, while insomnia was protective against transition to SNF. Surprisingly, dementia and neuropsychiatric symptoms did not increase risk of transition to SNF.

Conclusion

Survival time in AL is determined by factors similar to those operating on community-dwelling elderly, but dementia and neuropsychiatric symptoms do not alter survival time.

Keywords:  Assisted living , nursing home , dementia , chronic pain , insomnia , survival analysis

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 This study was supported by grants R01 MH 60626 and 1U01 MH 66136 from the National Institute of Mental Health.Conflict of interest: Dr Baker has been a grant awardee from Abbott Pharmaceuticals. Dr Rosenblatt has been a speaker, grant awardee, or consultant to Pfizer, Amarin, Forest, Astra Zenica, and Nova Research. Dr Lyketsos has been a speaker, grant awardee, or consultant to Forest Laboratories, Parke-Davis, Lilly, Janssen, Abbott, Bayer, Bristol-Meyers-Squibb, Pfizer/Eisai, NeuroLogic Inc, DuPont, Astra-Zeneca, Organon, Roche Parke-Davis (Warner-Lambert), Novartis, and Lundbeck. Dr Rabins has been a speaker for Pfizer, Lilly, Janssen, and Astra-Zeneca. Drs Rosenberg, Mielke, and Brandt, and Ms Samus have no financial relationships to disclose. Drs Rosenblatt, Lyketsos, Baker, Brandt, and Rabins provided study concept and design. Drs Rosenblatt, Lyketsos, Baker, Brandt, and Rabins, and Ms Samus provided acquisition of subjects and/or data. Drs Rosenberg, Lyketsos, and Mielke provided analysis and interpretation of data. Drs Rosenberg, Lyketsos, and Mielke prepared the manuscript.

PII: S1525-8610(05)00384-1

doi:10.1016/j.jamda.2005.06.003

JAMDA
Volume 7, Issue 2 , Pages 73-78, February 2006

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