Effect of Dementia and Treatment of Dementia on Time to Discharge from Assisted Living Facilities: The Maryland Assisted Living Study

Authors

  • Constantine G. Lyketsos MD, MHS,

    1. From the *Department of Psychiatry Johns Hopkins Bayview, Johns Hopkins MedicineDivision of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins UniversityCopper Ridge Institute, Sykesville, Maryland$Division of Medical Psychology, Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins UniversityDivision of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University.
    Search for more papers by this author
  • Quincy M. Samus MS,

    1. From the *Department of Psychiatry Johns Hopkins Bayview, Johns Hopkins MedicineDivision of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins UniversityCopper Ridge Institute, Sykesville, Maryland$Division of Medical Psychology, Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins UniversityDivision of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University.
    Search for more papers by this author
  • Alva Baker MD,

    1. From the *Department of Psychiatry Johns Hopkins Bayview, Johns Hopkins MedicineDivision of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins UniversityCopper Ridge Institute, Sykesville, Maryland$Division of Medical Psychology, Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins UniversityDivision of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University.
    Search for more papers by this author
  • Mathew McNabney MD,

    1. From the *Department of Psychiatry Johns Hopkins Bayview, Johns Hopkins MedicineDivision of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins UniversityCopper Ridge Institute, Sykesville, Maryland$Division of Medical Psychology, Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins UniversityDivision of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University.
    Search for more papers by this author
  • Chiadi U. Onyike MD, MHS,

    1. From the *Department of Psychiatry Johns Hopkins Bayview, Johns Hopkins MedicineDivision of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins UniversityCopper Ridge Institute, Sykesville, Maryland$Division of Medical Psychology, Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins UniversityDivision of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University.
    Search for more papers by this author
  • Lawrence S. Mayer MD, PhD,

    1. From the *Department of Psychiatry Johns Hopkins Bayview, Johns Hopkins MedicineDivision of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins UniversityCopper Ridge Institute, Sykesville, Maryland$Division of Medical Psychology, Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins UniversityDivision of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University.
    Search for more papers by this author
  • Jason Brandt PhD,

    1. From the *Department of Psychiatry Johns Hopkins Bayview, Johns Hopkins MedicineDivision of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins UniversityCopper Ridge Institute, Sykesville, Maryland$Division of Medical Psychology, Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins UniversityDivision of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University.
    Search for more papers by this author
  • Peter Rabins MD, MPH,

    1. From the *Department of Psychiatry Johns Hopkins Bayview, Johns Hopkins MedicineDivision of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins UniversityCopper Ridge Institute, Sykesville, Maryland$Division of Medical Psychology, Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins UniversityDivision of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University.
    Search for more papers by this author
  • Adam Rosenblatt MD

    1. From the *Department of Psychiatry Johns Hopkins Bayview, Johns Hopkins MedicineDivision of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins UniversityCopper Ridge Institute, Sykesville, Maryland$Division of Medical Psychology, Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins UniversityDivision of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University.
    Search for more papers by this author

Address correspondence to Constantine G. Lyketsos, MD, MHS, The Elizabeth Plank Althouse Professor and Chair, Department of Psychiatry, Johns Hopkins Bayview, 4940 Eastern Avenue, A4 Center, Room 458, Baltimore, MD 21224. E-mail: kostas@jhmi.edu

Abstract

OBJECTIVES: To estimate the association between dementia and time to discharge from individual assisted living (AL) facilities and examine, in residents with dementia, factors associated with shorter duration of residence in individual AL facilities.

DESIGN: Prospective cohort study.

SETTING: Twenty-two AL facilities in central Maryland.

PARTICIPANTS: Stratified random sample of 198 AL residents followed for a median of 18 months.

MEASUREMENTS: Detailed assessments to diagnose dementia; assess treatment of dementia; and rate clinical; cognitive, functional, and quality-of-life measures.

RESULTS: Residents with dementia remained in a facility 209 fewer days at the median (P=.001) than residents without dementia. After adjustment for other variables, lack of treatment for dementia (P=.01) and more-serious medical comorbidity (P=.02) were associated with earlier discharge in participants with dementia. Impaired mobility and limited activity participation had weaker associations with earlier time to discharge.

CONCLUSION: Dementia may accelerate time to discharge, and its treatment may attenuate this effect. The hypothesis that the detection and treatment of dementia might delay discharge from AL should be tested in randomized trials.

Ancillary