Abstract：
OBJECTIVE: 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.
METHODS: 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.
METHODS: All US Medicare- or Medicaid-certified NHs. Fee-for-service Medicare beneficiaries 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.
RESULTS: 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: 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.
METHODS: 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.
METHODS: All US Medicare- or Medicaid-certified NHs. Fee-for-service Medicare beneficiaries 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.
RESULTS: 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: 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.
摘要：
目的：了解长期居住在养老院（NH）的阿尔茨海默病和相关痴呆（ADRD）患者中的心理健康治疗的患病率，并探讨其使用的相关因素。
方法：回顾性队列研究。最低数据集数据（2017年4月-2018年9月），医疗保险总受益人摘要文件，B部分承运人文件和D部分处方文件用于识别精神疾病和ADRD诊断，患者特征,心理健康治疗。
方法：所有经美国医疗保险或医疗补助认证的NHs。65岁及以上的按服务收费的Medicare受益人，他们对ADRD进行了季度或年度最低数据集评估，并参加了MedicareB和D部分。两个队列：患有ADRD和精神疾病的居民；仅限患有ADRD的居民。
方法：主要结果：接受（1）任何心理健康治疗（药物或心理治疗）；（2）日历季度的任何心理治疗。
结果：抗精神病药，抗抑郁药,催眠药,抗癫痫药,短期会议（≤30分钟），长时间（≥45分钟），家庭/团体心理治疗。协变量包括易感，启用特性，需要因素。季度数据的广义估计方程模型，嵌套在患者体内，对每个队列中的每个结果进行估计。
结果：分析包括来自503,077个独特的NH长期居住居民的1,913,945个居民季度观察结果。总的来说,68.5%的NH长期居住的ADRD居民患有精神疾病；其中，85%的人接受了心理健康治疗。非洲裔美国人或西班牙裔居民不太可能使用抗抑郁药。非洲裔美国居民或居住在农村地区的居民不太可能接受长期心理治疗。西班牙裔居民更有可能接受长期心理治疗。少数民族居民更有可能接受团体/家庭心理治疗。
结论：大多数患有ADRD的NH长期住院居民患有精神疾病，其中大多数人接受了治疗。向非裔美国居民提供抗抑郁药或长期心理治疗的可能性较小。决定心理健康治疗效果的因素和种族差异的原因需要进一步探索。
方法：回顾性队列研究。最低数据集数据（2017年4月-2018年9月），医疗保险总受益人摘要文件，B部分承运人文件和D部分处方文件用于识别精神疾病和ADRD诊断，患者特征,心理健康治疗。
方法：所有经美国医疗保险或医疗补助认证的NHs。65岁及以上的按服务收费的Medicare受益人，他们对ADRD进行了季度或年度最低数据集评估，并参加了MedicareB和D部分。两个队列：患有ADRD和精神疾病的居民；仅限患有ADRD的居民。
方法：主要结果：接受（1）任何心理健康治疗（药物或心理治疗）；（2）日历季度的任何心理治疗。
结果：抗精神病药，抗抑郁药,催眠药,抗癫痫药,短期会议（≤30分钟），长时间（≥45分钟），家庭/团体心理治疗。协变量包括易感，启用特性，需要因素。季度数据的广义估计方程模型，嵌套在患者体内，对每个队列中的每个结果进行估计。
结果：分析包括来自503,077个独特的NH长期居住居民的1,913,945个居民季度观察结果。总的来说,68.5%的NH长期居住的ADRD居民患有精神疾病；其中，85%的人接受了心理健康治疗。非洲裔美国人或西班牙裔居民不太可能使用抗抑郁药。非洲裔美国居民或居住在农村地区的居民不太可能接受长期心理治疗。西班牙裔居民更有可能接受长期心理治疗。少数民族居民更有可能接受团体/家庭心理治疗。
结论：大多数患有ADRD的NH长期住院居民患有精神疾病，其中大多数人接受了治疗。向非裔美国居民提供抗抑郁药或长期心理治疗的可能性较小。决定心理健康治疗效果的因素和种族差异的原因需要进一步探索。
