Characterizing Alzheimers Disease and Serious Mental Illness Co-Occurrence Among Nursing Home Residents and Relationship to Symptomatology and Care Practices

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PROJECT SUMMARY/ABSTRACT Individuals with Alzheimer’s disease and related dementias (ADRD) experience progressive cognitive decline and behavioral and functional impairment. With disease progression, individuals with ADRD also experience heightened risk for poor outcomes which often culminate in the need for skilled care provided in nursing homes (NH); almost all individuals with ADRD will receive short- or long-term NH care at some point. While providing high-quality, person-centered ADRD care is a national priority, progress toward this goal is limited in part by a lack of understanding regarding the influence of major comorbidities on ADRD disease burden, care needs, and symptoms. In particular, comorbid serious mental illness (SMI), which is common among individuals with ADRD, remains understudied despite its impact on disease risk, burden, care needs, and symptomatology. Burden of both ADRD and SMI is particularly high in NH settings. Understanding whether SMI plays an additive role in shaping behavioral symptom presentation among individuals with ADRD, care needs (e.g. pain), and outcomes (e.g. falls) can inform intervention targets and improve person-centered care across settings. Towards this end, I propose a mixed methods sequential explanatory design to investigate the contribution of SMI to ADRD symptoms, outcomes, and care interventions; domains informed by the Need-Driven, Dementia-Compromised Behavior Model. I will utilize secondary data available through the Minimum Data Set 3.0 (MDS 3.0) (Aim 1/1A) and conduct interviews with NH staff (Aim 2). My long-term goal is to establish a program of research designing and delivering person-centered interventions for symptom management among adults with ADRD and complex comorbidities. My short-term objective is to characterize ADRD/SMI’s relationship to shared and distinct symptomology, outcomes, and care interventions; and implications for individuals with ADRD and provision of person-centered care. Under Aim 1, I will describe patterns and characteristics of comorbid ADRD/SMI diagnosis among NH residents using 2019 MDS 3.0 NH assessment data (N~500,000). Applying clustering techniques, I will define underlying ADRD/SMI disease co-occurrences and their variation by demographic characteristics. I will then evaluate how distinct ADRD/SMI comorbidities are associated with unique behavioral symptoms, outcomes (e.g. falls, functional status) and care needs/interventions (e.g. medication use, restraint use) as compared to ADRD alone (Aim 1A). Under Aim 2, I will explain and extend Aim1/1a findings by conducting content analysis of interviews with NH staff (e.g. nurses, nursing assistants, social workers, providers) (N=30, total) about their perceptions of ADRD/SMI comorbidities and care of residents with complex cognitive and psychiatric care needs. Impact: Findings from the proposed study are responsive to ADRD research priorities and will provide foundational data informing targets for person-centered care interventions for patients with ADRD/SMI by illuminating the contributory role of SMI to ADRD symptoms and care. The training plan will support my broader career goal of becoming a leading clinician scientist focused on aging and ADRD care.