Evaluation of demographics and medication use in patients with dementia in assisted living and skilled nursing facilities.

OBJECTIVE To compare demographics and treatment patterns for dementia patients residing in assisted living facilities (ALF) and skilled-nursing facilities (SNF). DESIGN Cross-sectional, retrospective chart review. SETTING Patients with dementia residing in five assisted living and six skilled-nursing facilities in Western Oregon and Tacoma, Washington. PATIENTS 119 assisted living and 190 SNF nursing patients with a diagnosis of dementia. MAIN OUTCOME MEASURES Similarities and differences in patient demographics, underlying comorbidity, duration of disease, and treatment characteristics for dementia. RESULTS The analysis revealed higher prevalence of non- Alzheimer's dementia, history of cerebral vascular accident, depression, and diabetes in the SNF cohort. There were higher proportions of assisted living patients having dementia of less than one-year's duration. Low proportions of patients in both settings were receiving treatment (44% of assisted living patients and 11% of SNF), despite the finding that 78% and 62% of assisted living and SNF patients had a dementia diagnosis of less than three years. In addition, when cholinesterase inhibitors were ordered, the dosing was not fully titrated in a majority of patients. Reduction in behavioral medication use in treated ALF patients but not in treated SNF patients also was observed. CONCLUSION This analysis revealed opportunities for intervention and improved treatment for patients with dementia in ALFs. There are opportunities to maximize treatment efficacy by initiating cholinesterase inhibitor medications and maximizing dose titration. To adequately quantify potential benefit of dementia treatment in SNF patients, additional studies with larger numbers of treated patients are needed.