Underrecognition of cognitive impairment in assisted living facilities

OBJECTIVES: To determine the prevalence of cognitive impairment (CI), dementia diagnosis and treatment, assistance with medications, and surrogate decision-makers for residents of assisted living facilities (ALFs). DESIGN: Cross-sectional study. SETTING: Seven ALFs in Omaha, Nebraska, and the surrounding area. None of the ALFs in this study were designated "Alzheimer's" or "dementia" facilities. PARTICIPANTS: Four hundred seven of 455 ALF residents were solicited, and 230 consented. The average age ± standard deviation of participants was 83.3 ± 8.3. MEASUREMENTS: ALF residents were examined using the Mini-Mental State Examination (MMSE), and their medical charts were reviewed. RESULTS: Fifty-eight percent of ALF residents had CI according to the MMSE. Of those with CI, 63% had no diagnosis of dementia, 75% were not treated for dementia, 41% with a documented diagnosis of dementia were not treated for dementia, 22% self-administered an average of 5.4 ± 3.4 medications daily, and 11% had surrogate decision makers. CONCLUSION: More than half of ALF residents in this study had CI and a significant percentage was undiagnosed. Even when diagnosed as dementia, CI is significantly undertreated in this setting. These deficits must be addressed to promote quality of care and the need for specialized attention.