Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Int Psychogeriatr. 2013 Dec;25(12):2047-56. doi: 10.1017/S1041610213001610. Epub 2013 Sep 23.
There is a lack of empirical evidence about the impact of regulations on dementia care quality in assisted living (AL). We examined cohort differences in dementia recognition and treatment indicators between two cohorts of AL residents with dementia, evaluated prior to and following a dementia-related policy modification to more adequately assess memory and behavioral problems.
Cross-sectional comparison of two AL resident cohorts was done (Cohort 1 [evaluated 2001-2003] and Cohort 2 [evaluated 2004-2006]) from the Maryland Assisted Living studies. Initial in-person evaluations of residents with dementia (n = 248) were performed from a random sample of 28 AL facilities in Maryland (physician examination, clinical characteristics, and staff and family recognition of dementia included). Adequacy of dementia workup and treatment was rated by an expert consensus panel.
Staff recognition of dementia was better in Cohort 1 than in Cohort 2 (77% vs. 63%, p = 0.011), with no significant differences in family recognition (86% vs. 85%, p = 0.680), or complete treatment ratings (52% vs. 64%, p = 0.060). In adjusted logistic regression, cognitive impairment and neuropsychiatric symptoms correlated with staff recognition; and cognitive impairment correlated with family recognition. Increased age and cognitive impairment reduced odds of having a complete dementia workup. Odds of having complete dementia treatment was reduced by age and having more depressive symptoms. Cohort was not predictive of dementia recognition or treatment indicators in adjusted models.
We noted few cohort differences in dementia care indicators after accounting for covariates, and concluded that rates of dementia recognition and treatment did not appear to change much organically following the policy modifications.
关于法规对辅助生活（AL）中痴呆症护理质量的影响，缺乏经验证据。我们研究了两个 AL 痴呆症居民队列的队列差异，这些差异是在与痴呆症相关的政策修改之前和之后评估的，以更充分地评估记忆和行为问题。
对马里兰州辅助生活研究中的两个 AL 居民队列进行了横断面比较（队列 1[评估 2001-2003 年]和队列 2[评估 2004-2006 年]）。从马里兰州的 28 个 AL 设施中随机抽取了一个队列，对患有痴呆症的居民（n=248）进行了初始的面对面评估（包括医生检查、临床特征以及工作人员和家属对痴呆症的识别）。专家共识小组对痴呆症的评估和治疗的充分性进行了评估。
队列 1 的工作人员对痴呆症的识别优于队列 2（77%对 63%，p=0.011），而家属的识别差异无统计学意义（86%对 85%，p=0.680），或完全治疗评分（52%对 64%，p=0.060）。在调整后的逻辑回归中，认知障碍和神经精神症状与工作人员的识别相关；认知障碍与家属的识别相关。年龄增加和认知障碍降低了进行完整痴呆症检查的可能性。年龄增加和抑郁症状更多会降低进行完整痴呆症治疗的可能性。在调整后的模型中，队列对痴呆症的识别或治疗指标没有预测作用。
在考虑了协变量后，我们注意到痴呆症护理指标的队列差异很少，并且得出结论，在政策修改后，痴呆症的识别和治疗率似乎没有明显变化。
