Prevalence and Medication Management of Dementia by a Medical Practice Providing Onsite Care in Assisted Living

Abstract

Background/objectives: Assisted living (AL) is an important provider of long-term residential care to people with dementia, but little research has used clinician's records-arguably the most reliable and valid source of medically related information. This article uses clinician records to examine the prevalence of dementia, treatment with dementia-specific medications and antipsychotic medications, and how prescribing varies by assisted living residence (ALR) and resident characteristics.

Design: Analysis of medical records from a long-term care medical practice.

Setting: Ninety ALRs that had onsite care provided to some or all of their residents by one group practice that specializes in home-based primary care.

Participants: Records for 3175 AL residents.

Measurements: Thirty-six variables related to the ALR, resident demographics, and medical conditions and pharmaceutical treatment.

Results: Seventy-six percent of patients had a documented diagnosis of dementia, 41% who were treated with a medication for dementia other than an antipsychotic, and 37% who received an antipsychotic. Dementia medications were more likely to be prescribed to patients with dementia living in ALRs that had a memory care unit, and also to patients who were not Medicaid beneficiaries. Antipsychotic prescribing was similarly more common for residents with dementia living in ALRs that had memory care units.

Conclusion: The 76% prevalence rate of dementia in ALRs larger than 25 beds may be a more accurate reflection of the prevalence of dementia reported elsewhere, because it is based on diagnoses documented by patients' primary care clinicians. The reporting of treatment rates for dementia medications and antipsychotics, and how they vary in relation to ALR and resident characteristics, is meant to generate discussion about "best practices" and standards of care in the medication management of dementia and its behavioral comorbidities-topics that have received scant attention to date other than widespread attention to the need to reduce antipsychotic prescribing.

Keywords: Alzheimer disease; Assisted living; anti-psychotic; long-term care practice; medications; memory care.