Alzheimer’s Association Dementia Care Practice Recommendations

Assisted living residences have become prominent sites of long-term residential care for older adults with dementia. Estimates derived from national data indicate that seven out of ten residents in these residences have some form of cognitive impairment, with 29 percent having mild impairment, 23 percent moderate impairment, and 19 percent severe impairment. More than one-third of residents display behavioral symptoms, and of these, 57 percent have a medication prescribed for their symptoms. Only a minority of cognitively impaired residents reside in a dementia special care unit, where admission and discharge policies are more supportive of their needs. Policy-relevant recommendations from our study include the need to examine the use of psychotropic medications and cultures related to prescribing, better train assisted living staff to handle medications and provide nonpharmacological treatments, use best practices in caring for people with dementia, and promote consumer education regarding policies and practices in assisted living.

This analysis evaluates the progression of Alzheimer disease (AD) severity and compares the life expectancy and nursing home placement rates for AD patients with the same measures in the general population. Data from the Consortium to Establish a Registry for Alzheimer Disease were analyzed to estimate expected survival, time spent in each Clinical Dementia Rating stage, and nursing home admission rate for a hypothetical cohort of patients aged 70 years with new-onset AD. Corresponding estimates for the US general population were calculated from the 2004 National Nursing Home Survey and the 2003 life table estimates from the US Census Bureau. Deaths from all causes by age 80 years are expected in 61% of AD patients and in 30% of the general population. From the age of 70 to 80 years, a typical AD patient spends 4 years at Clinical Dementia Rating stage 3 (severe), 3 years at stage 2 (moderate), and 3 years at stage 1 (mild). Nursing home admission by the age of 80 years is expected for approximately 75% of surviving AD patients, but for only 4% of the general population. Among persons aged > or =65 years, reported age-adjusted and sex-adjusted mortality rates for AD increased to 33% from 1999 to 2004.