Dementia and Psychiatric Disorders in Assisted Living

描述(由申请人提供)：辅助生活(AL)在过去15年中迅速增长，但对AL居民的精神疾病发病率知之甚少。这次重新提交是马里兰州辅助生活研究(1R01 MH60626)的五年延续。MD-AL是一个为期两年的项目，旨在评估分层随机抽样的辅助生活居民中痴呆症和精神障碍的患病率。到目前为止，这项研究已经完成了对150名居民的评估，预计最终招募200人。参与者接受痴呆症的全面评估，这是一项标准化的精神检查，并根据量化痴呆症相关行为障碍、一般医疗并存、功能(IADL和ADL)损害、生活质量和照顾者负担的量表进行评级。收集有关服务需求的信息。收集了AL设施、居民的主要照顾者和家庭线人的基本数据。研究小组已经获得了关键的经验，并召集了一批设施和居民进行进一步研究。我们的数据首次提供了对AL精神发病率的直接估计：初步分析表明，69%的AL居民患有痴呆症，其中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，在AL中，只有不到1/2的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症和其他精神疾病对两个关键AL结果的影响：生活质量和就地老化的能力。这将通过继续对最初的200名研究参与者进行每半年一次的亲自跟踪，并通过招募在过去3个月内进入AL的另外200名居民来实现；居民将被跟踪到死亡或从AL出院，或最多三年。这将允许对AL居民的痴呆症和其他精神障碍的病程、检测和治疗(目标1)、痴呆症和其他精神疾病(治疗和未治疗)对生活质量的影响(目标2)以及死亡或出院时间(目标3)进行纵向研究。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。它们将提供有关精神疾病对生活辅助居民(预计到2025年将达到390万人)就地养老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、辅助生活行业和普通公众非常感兴趣。研究结果可能会影响辅助生活的临床实践，导致实施基于辅助生活的痴呆症和其他精神障碍的筛查和治疗计划，这将使居民受益，并可能改善生活质量，推迟出院。

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.