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

项目摘要 2016年，近80万美国人是疗养院(NH)的长期居民。而45%的人患有痴呆症， 超过30%的人被诊断为精神疾病。事实上，NHS是护理的最重要的机构环境 患有双相情感障碍、精神分裂症或其他精神障碍的成年人(“严重精神疾病”[SMI] 此后)。患有SMI的人比没有SMI的人更有可能在NH度过时间，并且 在过去十年中，患有SMI的NH居民的比例几乎翻了一番，到2017年增长到18.6%。 然而，理解对SMI的NH护理还需要考虑阿尔茨海默病和相关的痴呆症 (ADRD)因为病情有着千丝万缕的联系：在55-收治的精神分裂症患者中 NHS，12.2%的人患有ADRD，在85岁的老年人中，ADRD的患病率上升到80.5%，远远超过ADRD的患病率 在普通人群中。国家投资局战略计划的项目C-4强调需要“改进和降低成本-- 有效的方法。。。提高老年人应对慢性病的能力“，而里程碑13.N AD+ADRD研究实施里程碑侧重于了解以下机制和来源 患有ADRD的人之间存在差异。SMI由老年人可能患有的慢性疾病组成 需要广泛的支持，并经历了巨大的差距。尽管NH居民的人口不断增长 由于SMI和他们沉重的ADRD负担，关于他们的护理存在巨大的信息真空 收到。在此解释性混合方法分析中，我们将使用最小数据集(MDS)与 将居民、设施和社区特征联系起来，以识别在美国进入NH的个人 设施。我们将研究与成为养老院住院医生的可能性相关的特征， 具体检查与叠加在SMI上的ADRD相关的风险。接下来，在那些成为 长期入住疗养院的居民，我们将检查潜在的可避免的住院-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，我们将考虑 精神卫生保健(例如，精神科住院、使用束缚、抗精神病药物处方)、检查 对于患有和不患有ADRD的人来说是不同的。我们将使用此信息来选择性能异常值工具 我们将在那里与医务主任、护理主任、精神科顾问医生进行面谈，并指导 护理人员确定为受SMI影响的居民提供高质量护理的障碍和促进者 阿德勒。我们将整合我们的定量和定性结果，以确定关键的挑战和潜力 改善对NH中SMI和ADRD患者的护理服务的解决方案。这项创新的建议将 提供对NIA总体战略计划以及AD+ADRD目标至关重要的信息 研究实施里程碑。

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.