The Impact of Alzheimer’s Disease and Related Dementias on Nursing Home Care and Quality for Persons with Serious Mental Illness

阿尔茨海默病和相关痴呆症对严重精神疾病患者的疗养院护理和质量的影响

• 批准号: 10803736
• 负责人: DONOVAN T MAUST
• 金额: $ 210.92万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10803736
• 关键词: Admission activity; Adult; Agitation; Alzheimer' s disease related dementia; Alzheimer' s disease risk; American; Antipsychotic Agents; Bathing; Behavioral Symptoms; Bipolar Disorder; Caring; Characteristics; Chronic; Chronic Disease; Cognitive; Communities; Data; Data Set; Dementia; Disparity; Elderly; Emergency department visit; General Population; Goals; High Prevalence; Home Nursing Care; Hospitalization; Illness impact; Individual; Institution; Intervention; Interview; Leadership; Link; Medical; Medicare claim; Medicare/Medicaid; Mental Health; Mental Health Services; Mental disorders; Methods; Nurse Administrator; Nursing Homes; Outcome; Performance; Persons; Physician Executives; Policies; Population; Prevalence; Psychiatric Diagnosis; Psychiatrist; Psychoses; Psychotic Disorders; Quality of Care; Records; Rehabilitation therapy; Research; Residencies; Risk; Risk Adjustment; Role; Running; Sampling; Schizophrenia; Skilled Nursing Facilities; Source; Strategic Planning; Structure; Symptoms; Time; Vacuum; Work; age group; burnout; care delivery; cohort; comorbidity; coping; cost effective; court; data integration; design; experience; high risk; high risk population; human very old age (85+); improved; informant; innovation; insight; nursing home length of stay; nursing skill; restraint; severe mental illness

PROJECT ABSTRACT In 2016, nearly 800,000 Americans were long-stay nursing home (NH) residents. While 45% have dementia, over 30% have a psychiatric diagnosis. In fact, NHs are the most important institutional setting of care for adults with bipolar disorder, schizophrenia, or other psychotic disorders (“serious mental illness” [SMI] hereafter). Individuals with SMI are more likely to spend time in a NH than counterparts without SMI, and the proportion of NH residents with SMI has nearly doubled over the past decade, growing to 18.6% by 2017. However, understanding NH care for SMI requires also considering Alzheimer’s disease and related dementias (ADRD) because the conditions are inextricably linked: Among 55–64-year-olds with schizophrenia admitted to NHs, 12.2% have ADRD, which grows to 80.5% among 85-year-olds, far exceeding the prevalence of ADRD among the general population. Item C-4 of the NIA’s Strategic Plan highlights the need for “improved and cost- effective ways to . . . improve older adults’ ability to cope with chronic disease,” while Milestone 13.N of the AD+ADRD Research Implementation Milestones is focused on understanding mechanisms and sources of disparities among those living with ADRD. SMI is comprised of chronic conditions for which older adults may need extensive supports and experience significant disparities. Despite the growing population of NH residents with SMI and their significant burden of ADRD, there is an enormous information vacuum about the care they receive. In this explanatory mixed methods analysis, we will use the Minimum Data Set (MDS) paired with linked resident, facility, and community characteristics to identify individuals in the U.S. admitted to a NH facility. We will examine the characteristics associated with likelihood of becoming a nursing home resident, specifically examining the risk associated with ADRD superimposed on SMI. Next, among those who become long-stay nursing home residents, we will examine potentially avoidable hospitalization—again, focusing on risk associated with ADRD superimposed on SMI. Among those with SMI, we will consider the quality of mental health care (e.g., psychiatric hospitalization, use of restraints, antipsychotic prescriptions), examining differences for those with and without ADRD. We will use this information to select performance outlier facilities where we will conduct interviews with medical directors, nursing directors, consultant psychiatrists, and direct care staff to identify barriers and facilitators to providing high quality care to residents with SMI impacted by ADRD. We will integrate our quantitative and qualitative findings to identify key challenges and potential solutions to improve care delivery to individuals with SMI and ADRD in NH. This innovative proposal will provide crucial information critical to the goals of both the NIA overall Strategic Plan as well as the AD+ADRD Research Implementation Milestones.

项目摘要 2016年，近80万美国人长期居住在养老院（NH）。虽然45%患有痴呆症， 超过30%的人有精神病诊断。事实上，国家卫生机构是最重要的机构， 患有双相情感障碍、精神分裂症或其他精神障碍（“严重精神疾病”[SMI]）的成年人 此后）。患有严重精神分裂症的人比没有严重精神分裂症的人更有可能在医院度过时间，而且 在过去十年中，患有SMI的NH居民比例几乎翻了一番，到2017年增长到18.6%。 然而，了解NH护理SMI还需要考虑阿尔茨海默病和相关痴呆症 （ADRD），因为这些条件是密不可分的：在55-64岁的精神分裂症患者中， NHsADRD患病率为12.2%，85岁组高达80.5%，ADRD患病率远高于NHsADRD患病率 在一般人群中。NIA战略计划的C-4项强调了“改进和成本- 有效的方法。. .提高老年人科普慢性病的能力，”而《千年宣言》的里程碑13.N AD+ADRD研究实施里程碑的重点是了解机制和来源， 与ADRD患者之间的差异。SMI由慢性疾病组成，老年人可能 需要广泛的支持和经验的重大差距。尽管越来越多的居民 由于SMI和他们严重的ADRD负担，关于他们的护理存在巨大的信息真空， 接收。在这个解释性的混合方法分析中，我们将使用最小数据集（MDS）， 将居民、设施和社区特征联系起来，以识别美国NH收治的个人 设施。我们将研究与成为养老院居民的可能性相关的特征， 专门检查与ADRD叠加在SMI上相关的风险。接下来，在那些成为 长期入住疗养院的居民，我们将研究潜在的可避免的住院治疗-再次，重点是 与ADRD相关的风险叠加在SMI上。在那些有SMI的人中，我们会考虑 心理健康护理（例如，精神病住院，使用约束，抗精神病药物处方），检查 有和没有ADRD的人的差异。我们将使用这些信息来选择性能异常设施 在那里，我们将与医疗主任，护理主任，顾问精神病学家进行访谈，并直接 护理人员识别障碍和促进因素，为受影响的SMI居民提供高质量护理 ADRD。我们将整合我们的定量和定性研究结果，以确定关键的挑战和潜力 解决方案，以改善护理提供给个人与SMI和ADRD在NH。这一创新举措将 提供对国家信息评估总体战略计划和AD+ADRD目标至关重要的关键信息 研究实施里程碑。