Dementia and Psychiatric Disorders in Assisted Living

描述（由申请人提供）：辅助生活（AL）在过去15年中迅速发展，但对AL居民的精神发病率知之甚少。此次再申请是马里兰辅助生活研究（1R01 MH60626）的5年延续。MD-AL是一个为期两年的项目，旨在估计老年痴呆和精神疾病的患病率，在分层随机抽样的辅助生活居民。到目前为止，这项研究已经完成了对150名居民的评估，预计最终将招募200名居民。参与者接受痴呆的综合评估、标准化的精神检查，并根据量化痴呆相关行为障碍、一般医疗合并症、功能（IADL和ADL）损害、生活质量和照顾者负担的量表进行评分。收集有关服务需求的信息。基本数据收集在人工智能设施，居民的主要照顾者和家庭线人。研究小组已经获得了重要的经验，并召集了一批设施和居民进行进一步的研究。我们的数据提供了阿尔茨海默病患者精神疾病发病率的第一个直接估计：初步分析表明，69%的阿尔茨海默病患者患有痴呆症，28%患有另一种DSM-IV诊断，痴呆症或其他精神疾病的累积患病率为81%。分析表明，不到1/2的AL精神病发病率得到了适当的检测和管理，而且这种发病率与更大的残疾和更差的生活质量有关。现在，研究小组建议纵向评估痴呆和其他精神疾病对两个关键阿尔茨海默病结果的影响：生活质量和适应年龄的能力。这将通过对最初的200名研究参与者进行持续半年的亲自随访，并通过招募200多名在过去3个月内入住AL的住院医师来完成；居民将被跟踪至死亡或出院，或长达三年。这将允许对阿尔茨海默病患者痴呆症和其他精神疾病的病程、检测和治疗进行纵向研究（目标1），对痴呆症和其他精神疾病进行治疗和未经治疗对生活质量的影响（目标2），以及死亡或出院时间（目标3）。研究结果预计将对老年学、老年医学和老年精神病学产生重大影响。他们将提供有关精神疾病对辅助生活居民（预计到2025年将接近390万）能力的影响的基本信息。这些信息对医疗保健提供者、许可机构、政策制定者、辅助生活行业和公众非常有兴趣。研究结果可能会影响辅助生活的临床实践，从而导致基于辅助生活的痴呆症和其他精神疾病的筛查和治疗计划的实施，这将使居民受益，并可能提高生活质量，并延迟出院。

DESCRIPTION (provided by applicant): Assisted Living (AL) has grown rapidly over the last 15 years, but little is known about the psychiatric morbidity of AL residents. This resubmission is a five-year continuation of the Maryland Assisted Living Study (1R01 MH60626). MD-AL was a two-year project intended to estimate the prevalence of dementia and psychiatric disorders in a stratified random sample of assisted living residents. By this time, that study has completed assessment of 150 residents, with anticipated final recruitment of 200. Participants undergo a comprehensive evaluation for dementia, a standardized psychiatric examination, and are rated on scales quantifying dementia-associated behavioral disturbances, general medical co-morbidity, functional (IADL and ADL) impairment, quality of life, and caregiver burden. Information is collected on the need for services. Basic data are collected on the AL facility, the resident's primary caregiver and a family informant. The study team has acquired critical experience and assembled a cohort of facilities and residents for further study. Our data provide the first direct estimate of psychiatric morbidity in AL: preliminary analyses indicate that 69% of AL residents suffer from dementia, with 28% suffering from another DSM-IV diagnosis, and cumulative prevalence of dementia or another psychiatric disorder of 81%. Analyses indicate that less than 1/2 of psychiatric morbidity in AL is appropriately detected and managed, and that this morbidity is associated with greater disability and worse life quality. Now the study team proposes to assess longitudinally the impact of dementia and other psychiatric morbidity on two key AL outcomes: quality of life and the ability to age in place. This will be accomplished by continued semi-annual in person follow-up of the original 200 study participants and by the recruitment of 200 more residents who have been admitted to AL in the last 3 months; residents will be followed to death or discharge from AL, or for up to three years. This will permit longitudinal study of the course, detection, and treatment of dementia and other psychiatric disorders in AL residents (Aim 1), the impact of dementia and other psychiatric morbidity, treated and untreated, on quality of life (Aim 2), and time to death or discharge from the facility (Aim 3). Study findings are expected to have a substantial impact in gerontology, geriatric medicine and geriatric psychiatry. They will provide essential information about the consequences of psychiatric morbidity on the ability of assisted living residents (projected to approach 3.9 million by 2025) to age in place. This information is of great interest to healthcare providers, licensing agencies, policy makers, the assisted living industry and the general public. Study findings may affect clinical practices in assisted living resulting in the implementation of assisted living-based screening and treatment programs for dementia and other psychiatric disorders that will benefit residents, and may improve quality of life, and delay discharge.