Mental Health Treatment Among Nursing Home Residents With Alzheimer's Disease and Related Dementias

被引:0
|
作者
Huan, Tianwen [1 ,2 ]
Intrator, Orna [1 ,2 ]
Simning, Adam [1 ,3 ]
Boockvar, Kenneth [4 ,5 ]
Grabowski, David C. [6 ]
Cai, Shubing [1 ,2 ]
机构
[1] Univ Rochester, Dept Publ Hlth Sci, Rochester, NY USA
[2] Canandaigua VA Med Ctr, Geriatr & Extended Care Data & Anal Ctr, Canandaigua, NY USA
[3] Univ Rochester, Dept Psychiat, Rochester, NY USA
[4] Univ Alabama Birmingham, Div Gerontol Geriatr & Palliat Care, Birmingham, AL USA
[5] Birmingham VA Hlth Care Syst, Geriatr Res Educ & Clin Ctr, Birmingham, AL USA
[6] Harvard Med Sch, Dept Hlth Care Policy, Boston, MA USA
关键词
Alzheimer 's disease and related dementias; nursing homes; psychiatric disorders; psychiatric medication; psychotherapy; racial disparity; ANTIEPILEPTIC DRUGS; AGE; ANTIPSYCHOTICS; PSYCHOTHERAPY; SERVICES; QUALITY; RISK; CARE; PROVISION; VETERANS;
D O I
10.1016/j.jamda.2024.105088
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Objectives: To examine the prevalence of mental health treatment among nursing home (NH) long-stay residents with Alzheimer 's disease and related dementias (ADRD) and explore factors associated with utilization. Design: Retrospective cohort study. Minimum Data Set data (April 2017-September 2018), Medicare Master Beneficiary Summary File, Part B Carrier file and Part D prescription file were used to identify mental illness and ADRD diagnoses, patient characteristics, and mental health treatment. Setting and Participants: All US Medicare- or Medicaid-certi fied NHs. Fee-for-service Medicare bene fi- ciaries aged 65 and older who had a quarterly or annual Minimum Data Set assessment with ADRD and were enrolled in Medicare Parts B and D. Two cohorts: residents with both ADRD and psychiatric disorders; residents with ADRD only. Methods: Primary outcomes: receipt of (1) any mental health treatment (medication or psychotherapy); (2) any psychotherapy in a calendar quarter. Secondary outcomes: antipsychotics, antidepressants, hypnotics, antiepileptics, short-session ( <= 30 minutes), long-session ( >= 45 minutes), and family/group psychotherapy. Covariates included predisposing, enabling characteristics, and needs factors. Generalized Estimating Equation models of quarterly data, nested within patients, were estimated for each outcome among each cohort. Results: Analyses included 1,913,945 resident-quarter observations from 503,077 unique NH long-stay residents. Overall, 68.5% of NH long-stay residents with ADRD have psychiatric disorders; of these, 85% received mental health treatment. African American or Hispanic residents were less likely to use antidepressants. African American residents or residents living in rural locations were less likely to receive long-session psychotherapy. Hispanic residents were more likely to receive long-session psychotherapy. Residents in minority groups were more likely to receive group/family psychotherapy. Conclusions and Implications: Most of NH long-stay residents with ADRD had psychiatric disorders and most of them received treatment. Antidepressants or long-session psychotherapy were less likely to be provided to African American residents. Factors that determine the efficacy of mental health treatment and reasons for the racial disparities require further exploration. O 2024 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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页数:17
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