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