Assisted living residents with dementia go undiagnosed and are not adequately treated

Two-thirds of assisted living residents in central Maryland were diagnosed with dementia and more than one-quarter of residents had other psychiatric ailments, such as depression, anxiety disorder or psychosis, according to a Johns Hopkins study.

"These high rates indicate that many assisted living residents with dementia go undiagnosed and are not adequately treated," says Adam Rosenblatt, M.D., assistant professor of psychiatry at Johns Hopkins and lead author of the report appearing in the October 2004 issue of the Journal of the American Geriatric Association.

"This situation contrasts sharply with the goals of the assisted living movement, but it can be alleviated to some degree by providing psychiatric care to residents, ongoing consultation, and specialized nursing staff with training in dementia," says Rosenblatt.

For elderly people unable to live alone, assisted living programs aim to provide a stable residence, maximize quality of life and support their ability to age in place without discharge to a nursing home or hospital.

The study, known as the "Maryland Assisted Living Study," is an ongoing, long-term investigation that aims to obtain a direct estimate of the prevalence of dementia and other psychiatric disorders in assisted living residents and to determine the effect of these disorders on residents. The study was designed to provide information to health providers, policy makers, regulators, the assisted living industry and the general public.

The investigators reviewed health history and psychiatric evaluations in a randomized sample of assisted living residents in 22 (10 large and 12 small) randomly selected assisted living facilities in the city of Baltimore and seven Maryland counties. One hundred ninety-eight volunteers participated in the study. Seventy-five percent were aged 80 years and older and 78 percent were female. Overall rates of dementia and other psychiatric diseases were measured and adequate treatment history reviewed by an expert multidisciplinary panel.

The researchers found that two-thirds (67.7 percent) of participants had dementia according to the Diagnostic and Statistical Manual of Mental Disorders. Eighty-one percent of those in small facilities (less than 15 beds) and 63 percent in large facilities (more than 15 beds) had dementia. More than one-quarter (26.3 percent) had another psychiatric disorder, such as depression, anxiety disorder or psychosis. Seventy-three percent of dementias were adequately evaluated, but only 52 percent were adequately treated. Of those who had other psychiatric disorders, up to 61 percent were recognized, but only 52 percent were adequately treated.

By 1999 approximately 600,000 senior citizens in the United States were residents of assisted living facilities. An additional 1.5 million Americans resided in nursing homes.

Other authors of the report are Quincy Samus, Cynthia Steele, Alva Baker, Michael Harper, Jason Brandt, Peter Rabins and Constantine Lyketsos. The study was funded by the National Institute of Mental Health.