Treatments for Alzheimer’s and Dementia
Cognitive/Dementia
2024 Alzheimer’s Disease Facts and Figures
Alzheimer’s Association Special Report: Mapping a Better Future for Dementia Care Navigation
Be Well in AL Recommendations: Resident/Family Checklist
CEAL@UNC recognizes the benefit of ongoing quality improvement in assisted living, including through the implementation of consensus medical and mental health care recommendations disseminated through the Be Well in AL Initiative. This checklist, to be used by residents and their families considering or residing in assisted living, is a helpful tool to understand recommended care […]
Be Well in AL Recommendations: Resident/Family Checklist
CEAL@UNC recognizes the benefit of ongoing quality improvement in assisted living, including through the implementation of consensus medical and mental health care recommendations disseminated through the Be Well in AL Initiative. This checklist, to be used by residents and their families considering or residing in assisted living, is a helpful tool to understand recommended care […]
Changes in Nursing Staff Levels and Injury-Related Emergency Department Visits among Assisted Living Residents with Alzheimers Disease and Related Dementias
Objectives To examine the relationship between changes in nursing staff-hours per resident-day and injury-related emergency department (ED) visits among assisted living (AL) residents with Alzheimer disease and related dementias (ADRD). Design Retrospective cohort study. Setting and Participants We leveraged a data set of AL community characteristics in Ohio linked to Medicare claims data from 2007 […]
Changes in Nursing Staff Levels and Injury-Related Emergency Department Visits among Assisted Living Residents with Alzheimers Disease and Related Dementias
Objectives To examine the relationship between changes in nursing staff-hours per resident-day and injury-related emergency department (ED) visits among assisted living (AL) residents with Alzheimer disease and related dementias (ADRD). Design Retrospective cohort study. Setting and Participants We leveraged a data set of AL community characteristics in Ohio linked to Medicare claims data from 2007 […]
Prevalence and Correlates of Antipsychotic Medication Use in Oregon Assisted Living
Objective Investigate how assisted living and residential care (AL/RC) and memory care (MC) contexts are associated with the 90-day prevalence of antipsychotic medication use (APU), considered a quality measure in long-term care. Design All licensed AL/RC settings in Oregon received an annual mailed questionnaire to provide aggregate resident demographics, health acuity, health service use, payment […]
Prevalence and Correlates of Antipsychotic Medication Use in Oregon Assisted Living
Objective Investigate how assisted living and residential care (AL/RC) and memory care (MC) contexts are associated with the 90-day prevalence of antipsychotic medication use (APU), considered a quality measure in long-term care. Design All licensed AL/RC settings in Oregon received an annual mailed questionnaire to provide aggregate resident demographics, health acuity, health service use, payment […]
Serious Mental Illness in Assisted Living Communities: Association with Nursing Home Placement
Objectives Assess prevalence of serious mental illness (SMI) alone, and co-occurring with Alzheimer disease and related dementias (ADRD), among Medicare beneficiaries in assisted living (AL). Examine the association between permanent nursing home (NH) placement and SMI, among residents with and without ADRD. Design 2018-2019 retrospective cohort of Medicare beneficiaries in AL. Residents were followed for […]
Serious Mental Illness in Assisted Living Communities: Association with Nursing Home Placement
Objectives Assess prevalence of serious mental illness (SMI) alone, and co-occurring with Alzheimer disease and related dementias (ADRD), among Medicare beneficiaries in assisted living (AL). Examine the association between permanent nursing home (NH) placement and SMI, among residents with and without ADRD. Design 2018-2019 retrospective cohort of Medicare beneficiaries in AL. Residents were followed for […]
Bioethics in Gerontology: Developing a Typology of Ethical Issues in Assisted Living
Assisted living (AL) simultaneously is home to older adults who cannot live independently and a place where people work and visit and, therefore, where value conflicts are apt to arise. In this report we present the “Typology of Ethical Issues in Assisted Living” with emphasis on its development. The typology derives from a synthesis of […]
Bioethics in Gerontology: Developing a Typology of Ethical Issues in Assisted Living
Assisted living (AL) simultaneously is home to older adults who cannot live independently and a place where people work and visit and, therefore, where value conflicts are apt to arise. In this report we present the “Typology of Ethical Issues in Assisted Living” with emphasis on its development. The typology derives from a synthesis of […]
Examining Pain, Function, Behavioral Symptoms and Associations with Engagement in Meaningful Activity for Residents with Dementia in Assisted Living
Objectives The purpose of this study was to examine factors associated with engagement in meaningful activity among residents with dementia in assisted living. We hypothesized that greater functional independence, less pain, and lower behavioral and psychological symptom severity would be associated with higher engagement in meaningful activity after controlling for residents’ age, gender, comorbidities, and […]
Examining Pain, Function, Behavioral Symptoms and Associations with Engagement in Meaningful Activity for Residents with Dementia in Assisted Living
Objectives The purpose of this study was to examine factors associated with engagement in meaningful activity among residents with dementia in assisted living. We hypothesized that greater functional independence, less pain, and lower behavioral and psychological symptom severity would be associated with higher engagement in meaningful activity after controlling for residents’ age, gender, comorbidities, and […]
Do End-of-Life Outcomes Differ by Assisted Living Memory-Care Designation?
Background Residential care/assisted living (RC/AL) is an increasingly common place of end-of-life care for persons with Alzheimer’s disease and related dementia (ADRD), who have unique care needs as their health declines. Approximately 22% of RC/ALs provide specialized memory care (memory-care RC/AL). Understanding how end-of-life outcomes differ by memory care among residents with ADRD could facilitate […]
Do End-of-Life Outcomes Differ by Assisted Living Memory-Care Designation?
Background Residential care/assisted living (RC/AL) is an increasingly common place of end-of-life care for persons with Alzheimer’s disease and related dementia (ADRD), who have unique care needs as their health declines. Approximately 22% of RC/ALs provide specialized memory care (memory-care RC/AL). Understanding how end-of-life outcomes differ by memory care among residents with ADRD could facilitate […]
Assisted Living Residents with Dementia: Disparities in Mental Health Services Pre and During COVID-19
Background Little is known about mental health among Medicare beneficiaries with Alzheimer’s disease or related dementias (ADRD) who reside in assisted living (AL) communities. The COVID-19 pandemic may have curtailed ambulatory care access for these residents, but telehealth may have expanded it. We examined in-person and telehealth use of ambulatory mental health visits among AL […]
Assisted Living Residents with Dementia: Disparities in Mental Health Services Pre and During COVID-19
Background Little is known about mental health among Medicare beneficiaries with Alzheimer’s disease or related dementias (ADRD) who reside in assisted living (AL) communities. The COVID-19 pandemic may have curtailed ambulatory care access for these residents, but telehealth may have expanded it. We examined in-person and telehealth use of ambulatory mental health visits among AL […]
Effect of Immersive Virtual Reality Reminiscence versus Traditional Reminiscence Therapy on Cognitive Function and Psychological Well-being among Older Adults in Assisted Living Facilities: A Randomized Controlled Trial
WHAT THIS MEANS FOR YOU: A study of 60 assisted living residents observed the effects of virtual reality reminiscence and traditional reminiscence therapy on residents’ cognitive function and psychological wellbeing. Compared to a control group, there was a statistically significant increase in cognition and psychological wellbeing in both the reminiscence groups.
Effect of Immersive Virtual Reality Reminiscence versus Traditional Reminiscence Therapy on Cognitive Function and Psychological Well-being among Older Adults in Assisted Living Facilities: A Randomized Controlled Trial
WHAT THIS MEANS FOR YOU: A study of 60 assisted living residents observed the effects of virtual reality reminiscence and traditional reminiscence therapy on residents’ cognitive function and psychological wellbeing. Compared to a control group, there was a statistically significant increase in cognition and psychological wellbeing in both the reminiscence groups.
Primary Care Telemedicine Use among Assisted Living Residents with Dementia during COVID-19: Race and Dual Enrollment Status
WHAT THIS MEANS FOR YOU: This study used Medicare and CDC datasets to examine telemedicine primary care among 62,000 AL residents with dementia during the first year of the COVID-19 pandemic (2020). During the first three quarters of the pandemic, racially minoritized groups (Black, Hispanic) and Medicare-Medicaid dual eligibles were able to successfully use telemedicine at high rates. Gaps in primary care access between these groups and others (white, non-Medicaid eligible) were reduced due to telemedicine. This could inform CMS decisions about Medicare coverage for telemedicine primary care.
Primary Care Telemedicine Use among Assisted Living Residents with Dementia during COVID-19: Race and Dual Enrollment Status
WHAT THIS MEANS FOR YOU: This study used Medicare and CDC datasets to examine telemedicine primary care among 62,000 AL residents with dementia during the first year of the COVID-19 pandemic (2020). During the first three quarters of the pandemic, racially minoritized groups (Black, Hispanic) and Medicare-Medicaid dual eligibles were able to successfully use telemedicine at high rates. Gaps in primary care access between these groups and others (white, non-Medicaid eligible) were reduced due to telemedicine. This could inform CMS decisions about Medicare coverage for telemedicine primary care.
State Variation in Antipsychotic Use Among Assisted Living Residents With Dementia
WHAT THIS MEANS FOR YOU: This study of almost 21,000 AL residents in 2017 revealed that those with dementia were prescribed antipsychotics during about 13% of their time residing in AL. This proportion varied by state, with Hawaii having the lowest prescription rate (8%), and Wyoming having the highest (21%). Variations may be due to state regulation of AL communities, but the study was not able to determine if prescription practices were appropriate and tied to health outcomes.
State Variation in Antipsychotic Use Among Assisted Living Residents With Dementia
WHAT THIS MEANS FOR YOU: This study of almost 21,000 AL residents in 2017 revealed that those with dementia were prescribed antipsychotics during about 13% of their time residing in AL. This proportion varied by state, with Hawaii having the lowest prescription rate (8%), and Wyoming having the highest (21%). Variations may be due to state regulation of AL communities, but the study was not able to determine if prescription practices were appropriate and tied to health outcomes.
Psychotropic Medication Prescribing in Assisted Living and Nursing Home Residents with Dementia after the National Partnership
WHAT THIS MEANS FOR YOU: Using Medicare data for over 430,000 assisted living and long-stay nursing home residents, prescriptions for antipsychotic drugs decreased in both settings from 2010-2012 (before the National Partnership to Improve Dementia Care in Nursing Homes) to 2012-2017 (post-Partnership). However, assisted living prescribing decreased at a slower rate than nursing homes, meaning that the Partnership likely did not have a measurable impact in assisted living.
Psychotropic Medication Prescribing in Assisted Living and Nursing Home Residents with Dementia after the National Partnership
WHAT THIS MEANS FOR YOU: Using Medicare data for over 430,000 assisted living and long-stay nursing home residents, prescriptions for antipsychotic drugs decreased in both settings from 2010-2012 (before the National Partnership to Improve Dementia Care in Nursing Homes) to 2012-2017 (post-Partnership). However, assisted living prescribing decreased at a slower rate than nursing homes, meaning that the Partnership likely did not have a measurable impact in assisted living.
Injury-Related Emergency Department Use among Assisted Living Residents with Alzheimer’s Disease and Related Dementias
WHAT THIS MEANS FOR YOU: Using 2018 Medicare data for over 116,000 residents, residents with dementia had a 25% higher risk of going to the emergency room for injuries compared to those without dementia, as well as having a significantly higher chance of being hospitalized for injuries, regardless of whether they lived in general assisted living or memory care.
Injury-Related Emergency Department Use among Assisted Living Residents with Alzheimer’s Disease and Related Dementias
WHAT THIS MEANS FOR YOU: Using 2018 Medicare data for over 116,000 residents, residents with dementia had a 25% higher risk of going to the emergency room for injuries compared to those without dementia, as well as having a significantly higher chance of being hospitalized for injuries, regardless of whether they lived in general assisted living or memory care.
Excess Mortality Among Assisted Living Residents with Dementia during the COVID-19 Pandemic
WHAT THIS MEANS FOR YOU: Data from over 560,000 Medicare recipients revealed that residents with dementia experienced 33.4 more excess deaths per 100,000 compared to those without dementia during the COVID-19 pandemic. Residents in memory care communities did not have significantly different mortality rates compared to those in general assisted living settings.
Excess Mortality Among Assisted Living Residents with Dementia during the COVID-19 Pandemic
WHAT THIS MEANS FOR YOU: Data from over 560,000 Medicare recipients revealed that residents with dementia experienced 33.4 more excess deaths per 100,000 compared to those without dementia during the COVID-19 pandemic. Residents in memory care communities did not have significantly different mortality rates compared to those in general assisted living settings.
Successful Aging in Assisted Living: The Importance of Near Visual Acuity
Successful aging among independent community-dwelling older adults and those in residential settings is paramount to aging in place. The purpose of the current study was to explore how sensory, cognitive, and functional impairments affect successful aging in assisted living (AL) settings. Vision compromise was noted for near visual acuity (NVA) (14.3%) and distance visual acuity […]
Successful Aging in Assisted Living: The Importance of Near Visual Acuity
Successful aging among independent community-dwelling older adults and those in residential settings is paramount to aging in place. The purpose of the current study was to explore how sensory, cognitive, and functional impairments affect successful aging in assisted living (AL) settings. Vision compromise was noted for near visual acuity (NVA) (14.3%) and distance visual acuity […]
The Impact of FFC-AL-EIT-D in Assisted Living during the COVID-19 Pandemic
WHAT THIS MEANS FOR YOU: Function Focused Care was tested in 51 assisted living communities in one state during the COVID-19 pandemic. Although there was no change in resident falls, emergency room visits, hospitalizations, or transfers to nursing homes, organizational policies and environments supporting physical activity for residents improved.
The Impact of FFC-AL-EIT-D in Assisted Living during the COVID-19 Pandemic
WHAT THIS MEANS FOR YOU: Function Focused Care was tested in 51 assisted living communities in one state during the COVID-19 pandemic. Although there was no change in resident falls, emergency room visits, hospitalizations, or transfers to nursing homes, organizational policies and environments supporting physical activity for residents improved.
Dementia and COVID-19 Infection Control in Assisted Living in Seven States
WHAT THIS MEANS FOR YOU: The study examined how 119 assisted living administrators in 7 states implemented COVID-19 infection control practices from July 2020 to September 2021, including the feasibility of select infection control practices. Results indicated that although there were infection control challenges across all community types, dementia-specific communities faced the most difficulties. Less than half of administrators found it feasible to close indoor common areas, and residents, especially in dementia-specific communities, were less likely to wear masks and -wearing and physical distancing.
Dementia and COVID-19 Infection Control in Assisted Living in Seven States
WHAT THIS MEANS FOR YOU: The study examined how 119 assisted living administrators in 7 states implemented COVID-19 infection control practices from July 2020 to September 2021, including the feasibility of select infection control practices. Results indicated that although there were infection control challenges across all community types, dementia-specific communities faced the most difficulties. Less than half of administrators found it feasible to close indoor common areas, and residents, especially in dementia-specific communities, were less likely to wear masks and -wearing and physical distancing.
Assisted Living Residents With Dementia: Being Out in the World and Negotiating Connections
WHAT THIS MEANS FOR YOU: This year-long study observed 33 individuals and their caregivers in 4 assisted living communities, focusing on the significance of outdoor and offsite activities for persons living with dementia. Data included 1,560 observation hours, 114 interviews with residents, staff, family, and visitors, and resident record reviews. Qualitative findings suggested that engaging with others and with nature is important for better quality of life. Most residents were able to at least occasionally go out, and those who went outdoors generally had positive experiences, but not all experiences were positive.
Assisted Living Residents With Dementia: Being Out in the World and Negotiating Connections
WHAT THIS MEANS FOR YOU: This year-long study observed 33 individuals and their caregivers in 4 assisted living communities, focusing on the significance of outdoor and offsite activities for persons living with dementia. Data included 1,560 observation hours, 114 interviews with residents, staff, family, and visitors, and resident record reviews. Qualitative findings suggested that engaging with others and with nature is important for better quality of life. Most residents were able to at least occasionally go out, and those who went outdoors generally had positive experiences, but not all experiences were positive.
Staff Reports of Behavioral Expressions of Persons with Dementia in 250 Assisted Living Communities
WHAT THIS MEANS FOR YOU: This study included health care supervisors from 250 assisted living communities in 7 states to understand how staff respond to behavioral expressions of residents with dementia. The most commonly reported expressions were combativeness and anxiety. A thematic analysis found that in about 25% of cases, staff recognized the events preceding behavioral expressions (antecedents). Staff in smaller and memory-care only communities were more adept at identifying antecedents; additional training to anticipate expressions may help prevent them.
Staff Reports of Behavioral Expressions of Persons with Dementia in 250 Assisted Living Communities
WHAT THIS MEANS FOR YOU: This study included health care supervisors from 250 assisted living communities in 7 states to understand how staff respond to behavioral expressions of residents with dementia. The most commonly reported expressions were combativeness and anxiety. A thematic analysis found that in about 25% of cases, staff recognized the events preceding behavioral expressions (antecedents). Staff in smaller and memory-care only communities were more adept at identifying antecedents; additional training to anticipate expressions may help prevent them.
Potential Side Effects and Adverse Events of Antipsychotic Use for Residents With Dementia in Assisted Living: Implications for Prescribers, Staff, and Families
WHAT THIS MEANS FOR YOU: This study examined the use of antipsychotic medications among residents with dementia in 91 AL communities across seven states. The prevalence of potential side effects was high (93%) and of possible adverse events low, (6%), potentially associated with medication side effects. Quetiapine (Seroquel) and risperidone (Risperdal) were the most frequently prescribed antipsychotics. Most, but not all, residents’ family members were aware of their relative’s antipsychotic use.
Potential Side Effects and Adverse Events of Antipsychotic Use for Residents With Dementia in Assisted Living: Implications for Prescribers, Staff, and Families
WHAT THIS MEANS FOR YOU: This study examined the use of antipsychotic medications among residents with dementia in 91 AL communities across seven states. The prevalence of potential side effects was high (93%) and of possible adverse events low, (6%), potentially associated with medication side effects. Quetiapine (Seroquel) and risperidone (Risperdal) were the most frequently prescribed antipsychotics. Most, but not all, residents’ family members were aware of their relative’s antipsychotic use.
The Impact of Cognitive Impairment on Clinical Symptoms, Physical Activity and Care Interactions among Residents in Assisted Living Settings
WHAT THIS MEANS FOR YOU: This study included 550 AL residents from 59 communities, and assessed how cognitive impairment relates to physical activity, pain, and willingness to receive staff-assisted function-focused care. It found that cognitively impaired residents were less active, experienced more pain, and were less interested in staff-assisted function-focused care activities.
The Impact of Cognitive Impairment on Clinical Symptoms, Physical Activity and Care Interactions among Residents in Assisted Living Settings
WHAT THIS MEANS FOR YOU: This study included 550 AL residents from 59 communities, and assessed how cognitive impairment relates to physical activity, pain, and willingness to receive staff-assisted function-focused care. It found that cognitively impaired residents were less active, experienced more pain, and were less interested in staff-assisted function-focused care activities.
