Mental health problems in assisted living residents higher than expected

The first large scale comparative study of the mental health of assisted living residents has found a higher rate than expected of a range of mental health problems in this rapidly growing population.

The study which, appears in the October issue of the Journal of the American Geriatrics Society, reports that two thirds of 2100 assisted living residents studied exhibited mental health problem indicators. Half suffered from dementia and a quarter exhibited indicators of depression.

More than half the assisted living residents studied took psychotropic medications including antipsychotics, antidepressants or sedatives. “These findings, that the rate of mental health problems in the assisted living population is as high as the rate of mental health problems in nursing home patients, and much higher than the 6 to 7 percent of individuals with depression or dementia found in the age 65 and older population seen by primary care physicians is rather surprising,” said study co-author Malaz Boustani, M.D., assistant professor of medicine at the Indiana University School of Medicine and Regenstrief Institute, Inc. research scientist. “Now that we know that a significant proportion of assisted living residents have mental health problems, we need to work with assisted living residents, administrators, healthcare providers, policy makers and advocates to ensure that these facilities can accommodate their residents without over-medicating. And we don’t want to repeat the overregulation errors we have made with nursing home care,” he said.

Dr. Boustani and his fellow researchers studied a random sample of assisted living residents at 193 facilities in four states, interviewing the residents, observing them within their environment, reviewing their medical charts, and talking with their health care providers. The residents lived in three types of assisted living environments – “mom and pop” operations (16 or less residents and not part of a chain), nursing home-like facilities and hotel-like facilities with active social programs.

Dr. Boustani collegeagues found that over a third of all the assisted living residents they studied had actual behavioral problems. These included:

• 22 percent demonstrated verbal behavioral symptoms such as constant humming, or repeating questions
• 20 percent exhibited physical behavioral problems such as wandering, pacing, restlessness or hoarding
• 13 percent had aggressive behavior problems such as hitting, throwing objects or spitting at others.

Type of assisted living environment appeared to be statistically insignificant except that residents of “mom and pop” facilities had more aggressive behavior problems.”Now that we know that a significant proportion of assisted living residents have mental health problems, we need to work with assisted living residents, administrators, healthcare providers, policy makers and advocates to ensure that these facilities can accommodate their residents without over-medicating,” Dr. Boustani said. “And we don’t want to repeat the overregulation errors we have made with nursing home care.”

The researchers studied a random sample of assisted living residents at 193 facilities in four states, interviewing the residents, observing them within their environment, reviewing their medical charts, and talking with their health care providers. The residents lived in three types of assisted living environments – “mom and pop” operations (16 or less residents and not part of a chain), nursing home-like facilities and hotel-like facilities with active social programs.

“When we tried to find risk factors for these behaviors we found that those individuals with depression, dementia, or functional dependency such as inability to walk without assistance were at higher risk for demonstrating behavioral problems,” he said. “Clinicians need to change how we look at assisted living residents,” Dr. Boustani added. “We don’t need to institutionalize them – we should accommodate them.” said Dr. Boustani.