O2‐08‐04: Resident and facility determinants of long‐term care placement among older adults with dementia residing in assisted living facilities
Bibliographic record
Abstract
Background: Assisted Living is an increasingly important, yet poorly defined, setting for residential care of seniors with Alzheimer's disease and related disorders (ADRD). The AL philosophy implies that older adults receiving care will age in place, but admission and discharge criteria often make that impossible. The lower staffing rates and variability in services across facilities suggest the potential for poorer detection/management of emerging health issues and adverse health outcomes among ADRD residents. Our aim was to identify resident- and facility-level predictors of long-term care (LTC) placement and mortality over 1-year among older adults with ADRD across Designated Assisted Living (DAL) facilities in Alberta. Among 1,089 DAL residents aged 65+ (from 59 facilities) participating in the Alberta Continuing Care Epidemiologic Studies (ACCES), 58% (627) had a diagnosis of ADRD. Research nurses completed interRAI-AL resident assessments and interviewed family caregivers at baseline and 1-year (including discharge/decedent interviews). Standardized interviews with DAL administrators/managers provided facility-level data. Key predictors were examined using multivariate Cox proportional hazards regression models (with adjustment for clustering and competing risks). The cumulative incidence of LTC placement was 24.0% (95%CI 20.6-27.4) by 1 year, with an incidence rate of 29.9 per 100 person-years. Baseline resident characteristics significantly associated with placement included: greater health instability & cognitive impairment, mobility impairment, severe aggressive behaviours, urinary incontinence, previous hospitalizations, low activity levels and poor social engagement. Facility factors significantly associated with LTC placement were: <24 hrs/7 day LPN/RN coverage on-site (increased risk) and a higher number of DAL spaces within the facility (decreased risk). Other resident- (e.g., age, sex, ADL impairment, comorbidity, drug use) and facility-level characteristics (e.g., for-profit status, multi-level care, physician/specialist involvement) were not significant predictors in adjusted analyses. Conclusion(s): Assisted Living is rapidly expanding as a housing option for seniors with significant cognitive and functional needs. While often viewed as an alternative to traditional LTC care, one quarter of DAL residents with ADRD in Alberta required LTC admission over one year. Our findings on resident and facility predictors of institutionalization highlight various clinical and policy areas where targeted interventions may prevent or delay LTC admissions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".