2025 Alzheimer’s Disease Facts and Figures
Medical Care
Urinary Incontinence Is an Independent Risk Factor for Nursing Home Placement among Assisted Living Residents
WHAT THIS MEANS FOR YOU: This retrospective cohort study used 2019-2021 Medicare data to evaluate if urinary incontinence (UI) is an independent risk factor for assisted living residents' nursing home (NH) placement. Out of 247,010 residents, 20.5% had UI, and out of the 15.7% that were placed in NH, 21.7% had UI. The study confirmed that UI is an independent risk factor associated with NH placement, indicating education and early identification/treatment of UI will be helpful for avoiding/delaying NH placement.
Urinary Incontinence Is an Independent Risk Factor for Nursing Home Placement among Assisted Living Residents
WHAT THIS MEANS FOR YOU: This retrospective cohort study used 2019-2021 Medicare data to evaluate if urinary incontinence (UI) is an independent risk factor for assisted living residents’ nursing home (NH) placement. Out of 247,010 residents, 20.5% had UI, and out of the 15.7% that were placed in NH, 21.7% had UI. The study confirmed that UI is an independent risk factor associated with NH placement, indicating education and early identification/treatment of UI will be helpful for avoiding/delaying NH placement.
Understanding Urinary Incontinence and Urinary Tract Infections as Key Contributors to Falls in Assisted Living and Memory Care Communities
WHAT THIS MEANS FOR YOU: This editorial examined how urinary incontinence (UI) and urinary tract infections (UTIs) are contributors to falls for assisted living and memory care residents. Impacts on balance, stability, confusion, and fatigue all contribute to the increased risk. Future falls prevention approaches should consider UI and UTIs, structured toileting, and caregiver training to reduce risk.
Understanding Urinary Incontinence and Urinary Tract Infections as Key Contributors to Falls in Assisted Living and Memory Care Communities
WHAT THIS MEANS FOR YOU: This editorial examined how urinary incontinence (UI) and urinary tract infections (UTIs) are contributors to falls for assisted living and memory care residents. Impacts on balance, stability, confusion, and fatigue all contribute to the increased risk. Future falls prevention approaches should consider UI and UTIs, structured toileting, and caregiver training to reduce risk.
Medical Care Provider Involvement in Ontario Assisted Living Homes: A Descriptive Cross-Sectional Survey Analysis
WHAT THIS MEANS FOR YOU: This cross-sectional Canadian study examined 88 AL communities' survey responses to assess medical care provider involvement. A total of 54 AL communities had an established medical care provider, and doctors cared for more than 50 patients in 36% of homes and 46% visited homes weekly. Almost two-thirds of communities had nurses accompany physicians on rounds, and two-thirds provided residents with palliative care. Residents in homes with medical care providers were 76% less likely to seek care from a physician in the community.
Medical Care Provider Involvement in Ontario Assisted Living Homes: A Descriptive Cross-Sectional Survey Analysis
WHAT THIS MEANS FOR YOU: This cross-sectional Canadian study examined 88 AL communities’ survey responses to assess medical care provider involvement. A total of 54 AL communities had an established medical care provider, and doctors cared for more than 50 patients in 36% of homes and 46% visited homes weekly. Almost two-thirds of communities had nurses accompany physicians on rounds, and two-thirds provided residents with palliative care. Residents in homes with medical care providers were 76% less likely to seek care from a physician in the community.
Residency in Long-Term Care Facilities: An Important Risk Factor for Respiratory Syncytial Virus Hospitalization
WHAT THIS MEANS FOR YOU: This three-year prospective study in New York examined residential long-term care settings and risk associated with hospitalization due to respiratory syncytial virus (RSV), as compared with their community-dwelling peers. Residents in AL and NH settings were more likely to have dementia and congestive heart failure, creating intersections of risk factors for RSV. Residents of AL communities had 3-9 times higher, and residents of SNFs had 3-4 times higher, rates of RSV-associated hospitalizations than community dwelling residents. This study demonstrates the need for RSV vaccine recommendations in long-term care.
Residency in Long-Term Care Facilities: An Important Risk Factor for Respiratory Syncytial Virus Hospitalization
WHAT THIS MEANS FOR YOU: This three-year prospective study in New York examined residential long-term care settings and risk associated with hospitalization due to respiratory syncytial virus (RSV), as compared with their community-dwelling peers. Residents in AL and NH settings were more likely to have dementia and congestive heart failure, creating intersections of risk factors for RSV. Residents of AL communities had 3-9 times higher, and residents of SNFs had 3-4 times higher, rates of RSV-associated hospitalizations than community dwelling residents. This study demonstrates the need for RSV vaccine recommendations in long-term care.
Paucity of Published Data and Protocols for Hypoglycemia Management in Long-term Care
WHAT THIS MEANS FOR YOU: This systematic review examined established hypoglycemia protocols in LTC settings and assessed their effects on patient outcomes and healthcare resource use. Only 5 articles met the inclusion criteria and only 2 publications involved specific treatment protocols in long-term care settings, indicating a lack of published research on this issue.
Paucity of Published Data and Protocols for Hypoglycemia Management in Long-term Care
WHAT THIS MEANS FOR YOU: This systematic review examined established hypoglycemia protocols in LTC settings and assessed their effects on patient outcomes and healthcare resource use. Only 5 articles met the inclusion criteria and only 2 publications involved specific treatment protocols in long-term care settings, indicating a lack of published research on this issue.
Postimplementation Evaluation in Assisted Living Facilities of an eHealth Medical Device Developed to Predict and Avoid Unplanned Hospitalizations: Pragmatic Trial
WHAT THIS MEANS FOR YOU: This study tested a new monitoring system to predict risk of emergency hospitalizations in seven French AL communities. For the 118 included residents, 38 emergency hospitalizations were documented, and 50% of alerts from the system led to health care interventions. Hospitalizations were correlated with a lack of alert-triggered interventions, suggesting the system leads to improvements.
Postimplementation Evaluation in Assisted Living Facilities of an eHealth Medical Device Developed to Predict and Avoid Unplanned Hospitalizations: Pragmatic Trial
WHAT THIS MEANS FOR YOU: This study tested a new monitoring system to predict risk of emergency hospitalizations in seven French AL communities. For the 118 included residents, 38 emergency hospitalizations were documented, and 50% of alerts from the system led to health care interventions. Hospitalizations were correlated with a lack of alert-triggered interventions, suggesting the system leads to improvements.
Examining Care Network Characteristics in Older Adults’ Relocation to Residential Care Settings
WHAT THIS MEANS FOR YOU: This study used data from the National Health and Aging Trends Study to examine risk associated with older adults transitioning to residential care, specifically their care networks (involvement of multiple helpers). A total of 7,085 initially community-dwelling older adults were followed over 8 years, and the greatest risk for transitioning was having a care network with shared medical tasks, followed by sharing household tasks. Shared mobility, transportation, or self-care responsibilities decreased the risk. Having a close family member as a primary caregiver could act as a protective factor that decreases risk of transitioning into residential care.
Examining Care Network Characteristics in Older Adults’ Relocation to Residential Care Settings
WHAT THIS MEANS FOR YOU: This study used data from the National Health and Aging Trends Study to examine risk associated with older adults transitioning to residential care, specifically their care networks (involvement of multiple helpers). A total of 7,085 initially community-dwelling older adults were followed over 8 years, and the greatest risk for transitioning was having a care network with shared medical tasks, followed by sharing household tasks. Shared mobility, transportation, or self-care responsibilities decreased the risk. Having a close family member as a primary caregiver could act as a protective factor that decreases risk of transitioning into residential care.
Treatments for Alzheimer’s and Dementia
Prevalence Rates of Diabetic Retinopathy and Undiagnosed Diabetes Among Delaware Nursing Home and Assisted Living Facility Residents
WHAT THIS MEANS FOR YOU: This cross-sectional study examined eye test data from 2005-2009 in 22 facilities in Delaware to find prevalence of undiagnosed diabetes in assisted living and nursing home residents. A total of 3.6% of residents had hemorrhages in at least one eye, and of these residents, only 56.8% had a diabetes diagnosis, which is connected to eye hemorrhages. The results suggest a need for regular eye care for diabetic and non-diabetic residents to prevent adverse outcomes.
Prevalence Rates of Diabetic Retinopathy and Undiagnosed Diabetes Among Delaware Nursing Home and Assisted Living Facility Residents
WHAT THIS MEANS FOR YOU: This cross-sectional study examined eye test data from 2005-2009 in 22 facilities in Delaware to find prevalence of undiagnosed diabetes in assisted living and nursing home residents. A total of 3.6% of residents had hemorrhages in at least one eye, and of these residents, only 56.8% had a diabetes diagnosis, which is connected to eye hemorrhages. The results suggest a need for regular eye care for diabetic and non-diabetic residents to prevent adverse outcomes.
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 […]
The Experiences of Routine Powered Mobility Users in an Assisted Living Facility: A Case Study
WHAT THIS MEANS FOR YOU: A case study of 2 powered mobility device (PMD) users in the same AL community in Ohio used interviews, observational data, and digital image profiling to understand their experiences. The main themes to emerge were initial disapproval of needing a PMD, the actual need for PMD to enable movement, its impact on independence, and training – or a lack thereof – for using the PMD.
The Experiences of Routine Powered Mobility Users in an Assisted Living Facility: A Case Study
WHAT THIS MEANS FOR YOU: A case study of 2 powered mobility device (PMD) users in the same AL community in Ohio used interviews, observational data, and digital image profiling to understand their experiences. The main themes to emerge were initial disapproval of needing a PMD, the actual need for PMD to enable movement, its impact on independence, and training – or a lack thereof – for using the PMD.
Changes in Nursing Staff Levels and Injury-Related Emergency Department Visits among Assisted Living Residents with Alzheimers Disease and Related Dementias
WHAT THIS MEANS FOR YOU: An analysis of 2007-2015 Medicare data for over 12,000 AL residents with ADRD in 455 Ohio AL communities showed that higher levels of RN staffing hours per resident per day led to a 53% decrease in injury-related emergency department visits.
Changes in Nursing Staff Levels and Injury-Related Emergency Department Visits among Assisted Living Residents with Alzheimers Disease and Related Dementias
WHAT THIS MEANS FOR YOU: An analysis of 2007-2015 Medicare data for over 12,000 AL residents with ADRD in 455 Ohio AL communities showed that higher levels of RN staffing hours per resident per day led to a 53% decrease in injury-related emergency department visits.
CDC QuickStats: Percentage of Residential Care Communities That Use Electronic Health Records
Do-Not-Hospitalize Orders in Assisted Living Facilities: Direct Care Workers’ Perspectives
WHAT THIS MEANS FOR YOU: Eight participants were surveyed and interviewed to inform an intervention that would prevent direct care workers from sending residents with do-not-hospitalize orders to the hospital. Results revealed care workers were unfamiliar with do-not-hospitalize orders and had binary thinking (e.g., residents had to be sent to hospice or the hospital) on end-of-life issues. Supportive leaders in the assisted living communities that could assist direct care workers during these complex situations were found to be helpful.
Do-Not-Hospitalize Orders in Assisted Living Facilities: Direct Care Workers’ Perspectives
WHAT THIS MEANS FOR YOU: Eight participants were surveyed and interviewed to inform an intervention that would prevent direct care workers from sending residents with do-not-hospitalize orders to the hospital. Results revealed care workers were unfamiliar with do-not-hospitalize orders and had binary thinking (e.g., residents had to be sent to hospice or the hospital) on end-of-life issues. Supportive leaders in the assisted living communities that could assist direct care workers during these complex situations were found to be helpful.
Evacuation and Health Care Outcomes Among Assisted Living Residents After Hurricane Irma
WHAT THIS MEANS FOR YOU: Using 2017 Medicare data, researchers compared health outcomes from over 25,000 Florida AL residents who resided in an AL on the day of Hurricane Irma’s landfall and either sheltered in place (86% of residents) or evacuated (14% of residents). Evacuation was statistically significantly associated with a 16% higher risk of emergency department visits and with a 51% higher risk of nursing home admissions within 30 days of the hurricane, while hospitalization and mortality rates were similar between the two groups.
Evacuation and Health Care Outcomes Among Assisted Living Residents After Hurricane Irma
WHAT THIS MEANS FOR YOU: Using 2017 Medicare data, researchers compared health outcomes from over 25,000 Florida AL residents who resided in an AL on the day of Hurricane Irma’s landfall and either sheltered in place (86% of residents) or evacuated (14% of residents). Evacuation was statistically significantly associated with a 16% higher risk of emergency department visits and with a 51% higher risk of nursing home admissions within 30 days of the hurricane, while hospitalization and mortality rates were similar between the two groups.
Clinical Comorbidities and Transitions Between Care Settings Among Residents of Assisted Living Facilities: A Repeated Cross-Sectional Study
WHAT THIS MEANS FOR YOU: Administrative data from 2013-2019 in Ontario, Canada found a 34% increase in the resident population, and residents experienced increased instances of health conditions including renal disease, mental health issues, cardiac arrhythmias, diabetes, and cancer. Approximately 20% of residents still lived in an assisted living community at the end of the 6-year period, while 10% transitioned to nursing homes. In less than a decade, data revealed increasing medical complexity of assisted living residents, which must be considered for improved policy and practice.
Clinical Comorbidities and Transitions Between Care Settings Among Residents of Assisted Living Facilities: A Repeated Cross-Sectional Study
WHAT THIS MEANS FOR YOU: Administrative data from 2013-2019 in Ontario, Canada found a 34% increase in the resident population, and residents experienced increased instances of health conditions including renal disease, mental health issues, cardiac arrhythmias, diabetes, and cancer. Approximately 20% of residents still lived in an assisted living community at the end of the 6-year period, while 10% transitioned to nursing homes. In less than a decade, data revealed increasing medical complexity of assisted living residents, which must be considered for improved policy and practice.
Hospital Proximity and Emergency Department Use among Assisted Living Residents
WHAT THIS MEANS FOR YOU: This study assessed if the distance between AL communities and the nearest hospital was associated with the frequency of emergency department (ED) visits. Almost 541,000 Medicare beneficiaries aged 55 or older residing in over 16,500 AL communities in 2018-2019 were included. The median distance to the nearest hospital was 2.5 miles. Distance was related to ED use, especially for non-critical, visits, such that communities 5 or more miles from a hospital had fewer ED visits than those that were closer to a hospital.
Hospital Proximity and Emergency Department Use among Assisted Living Residents
WHAT THIS MEANS FOR YOU: This study assessed if the distance between AL communities and the nearest hospital was associated with the frequency of emergency department (ED) visits. Almost 541,000 Medicare beneficiaries aged 55 or older residing in over 16,500 AL communities in 2018-2019 were included. The median distance to the nearest hospital was 2.5 miles. Distance was related to ED use, especially for non-critical, visits, such that communities 5 or more miles from a hospital had fewer ED visits than those that were closer to a hospital.
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.
Recommendations for Medical and Mental Health Care in Assisted Living Based on an Expert Delphi Consensus Panel
Importance: Assisted living (AL) is the largest provider of residential long-term care in the US, and the morbidity of AL residents has been rising. However, AL is not a health care setting, and concern has been growing about residents’ medical and mental health needs. No guidance exists to inform this care. Objective: To identify consensus […]
Recommendations for Medical and Mental Health Care in Assisted Living Based on an Expert Delphi Consensus Panel
Importance: Assisted living (AL) is the largest provider of residential long-term care in the US, and the morbidity of AL residents has been rising. However, AL is not a health care setting, and concern has been growing about residents’ medical and mental health needs. No guidance exists to inform this care. Objective: To identify consensus […]
Health Care Use and Outcomes in Assisted Living Communities: Race, Ethnicity, and Dual Eligibility
WHAT THIS MEANS FOR YOU: Using Medicare data from 2018, data from over 255,000 people across 24,000 assisted living communities found differences in health outcomes based on race/ethnicity and dual eligibility, including hospital admissions, emergency room (ER) visits, and nursing home placements. For instance, Black and Hispanic residents had lower proportions of ER visits than their white counterparts, but Hispanic residents had higher 30-day readmission rates. Dual eligibility negatively impacted these outcomes more than race/ethnicity alone.
Health Care Use and Outcomes in Assisted Living Communities: Race, Ethnicity, and Dual Eligibility
WHAT THIS MEANS FOR YOU: Using Medicare data from 2018, data from over 255,000 people across 24,000 assisted living communities found differences in health outcomes based on race/ethnicity and dual eligibility, including hospital admissions, emergency room (ER) visits, and nursing home placements. For instance, Black and Hispanic residents had lower proportions of ER visits than their white counterparts, but Hispanic residents had higher 30-day readmission rates. Dual eligibility negatively impacted these outcomes more than race/ethnicity alone.
Impact of Dentures on Oral Health-Related Quality of Life in Assisted Living Facility Elders, Guntur District, Andhra Pradesh
WHAT THIS MEANS FOR YOU: This study investigated how wearing dentures affects the oral health-related quality of life and wellbeing of older adults residing in assisted living in India. Among 587 residents, those using removable partial dentures were more satisfied with their appearance and dental function than those with complete dentures. However, oral health impact (e.g., functional limitations, physical pain, social disability) was higher for complete denture users.
Impact of Dentures on Oral Health-Related Quality of Life in Assisted Living Facility Elders, Guntur District, Andhra Pradesh
WHAT THIS MEANS FOR YOU: This study investigated how wearing dentures affects the oral health-related quality of life and wellbeing of older adults residing in assisted living in India. Among 587 residents, those using removable partial dentures were more satisfied with their appearance and dental function than those with complete dentures. However, oral health impact (e.g., functional limitations, physical pain, social disability) was higher for complete denture users.
Bridging the Transition to Assisted Living: A Framework for Faith Community Nursing
WHAT THIS MEANS FOR YOU: Using an example of an 85-year-old resident, the article proposes a framework for faith community nursing, emphasizing observation, meaningful conversations, advocacy, and assertive communication to ease the move from independent to assisted living.
Bridging the Transition to Assisted Living: A Framework for Faith Community Nursing
WHAT THIS MEANS FOR YOU: Using an example of an 85-year-old resident, the article proposes a framework for faith community nursing, emphasizing observation, meaningful conversations, advocacy, and assertive communication to ease the move from independent to assisted living.
Impact of Function-Focused Care on Psychotropic Medications and Opioid Use among Assisted Living Residents
WHAT THIS MEANS FOR YOU: This study evaluated the impact of function focused care (which trains staff to evaluate residents’ functional capacity and physical activity to optimize their participation in activities) on the use of psychotropic medications and opioids. The study observed 794 residents across 85 communities over 12 months. There was a reduction in opioid use in the treatment group after four months; in the full sample during the overall study period, there was an increase in the use of benzodiazepines and antipsychotics.
Impact of Function-Focused Care on Psychotropic Medications and Opioid Use among Assisted Living Residents
WHAT THIS MEANS FOR YOU: This study evaluated the impact of function focused care (which trains staff to evaluate residents’ functional capacity and physical activity to optimize their participation in activities) on the use of psychotropic medications and opioids. The study observed 794 residents across 85 communities over 12 months. There was a reduction in opioid use in the treatment group after four months; in the full sample during the overall study period, there was an increase in the use of benzodiazepines and antipsychotics.
