Disruptive Behaviors in Nursing Home residents with Alzheimer's Disease and Related Dementias (ADRD) and Diabetes Mellitus

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PROJECT SUMMARY / ABSTRACT Disruptive behaviors, such as resistance to care or aggressive physical behaviors, are a critical outcome for persons with Alzheimer’s Disease and related dementias and their caregivers. For persons with dementia, disruptive behaviors are a sign of distress and suffering. For caregivers, disruptive behaviors increase stress, caregiver burnout and risk of injury. Unfortunately, our current understanding of disruptive behaviors is limited. Since 1) disruptive behaviors are often triggered by pain and discomfort and 2) persons with Alzheimer’s Disease and related dementias often have numerous comorbidities which can cause pain and discomfort, we propose to focus on diabetes as a model comorbidity to examine whether diabetes (e.g episodes of hyperglycemia) or diabetes treatments (e.g. fingerstick glucose measurements) are associated with disruptive behaviors in nursing home (NH) residents with dementia. The overarching goal of the UCSF Older Americans Independence Center (OAIC) is to prevent late-life disability when possible, and to improve the quality of life of older people with disability when prevention is not possible (amelioration). The proposed administrative supplement extends this goal specifically to vulnerable older adults residing in NHs who have Alzheimer’s disease and related dementias. This proposal fits within the conceptual framework that guides the UCSF OAIC, which holds that care for elders with disability and dementia must consider the wider medical and social context. We will leverage the expertise of the OAIC Data Analysis Core and the Veterans Affairs (VA) electronic health records including laboratory results and medication administration data with Minimum Data Set (MDS) data on disruptive behaviors. Our proposal will determine whether diabetes (including episodes of hypo- or hyper- glycemia) or diabetes treatments (including frequency of fingerstick measurements or insulin injections) are associated with disruptive behaviors (resistance to care, aggressive physical behaviors and aggressive verbal behaviors). In Aim 1, we propose to determine the prevalence of different types of disruptive behaviors by diabetes status in VA NH residents with Alzheimer’s Disease and related dementias. In Aim 2a, we will determine the association between diabetes treatments (fingersticks, insulin injections) and disruptive behaviors. In Aim 2b, we will determine the association between episodes of hypo- and hyper- glycemia with disruptive behaviors. Results from the proposed studies would provide critical preliminary data to support compelling NIA ADRD R01 applications focusing on disruptive behaviors and comorbidities in generalizable NH populations with dementia as well as intervention studies on whether modifying the care of comorbidities can decrease disruptive behaviors. This research aligns with the “NIA Strategic Directions for Research, 2020-2025” to improve our understanding of Alzheimer’s Disease and related dementias (Goal D) and to inform the development of interventions to maintain well-being and reduce the burden of age-related diseases (Goal C).