ArticleJournal of the American Geriatrics Society2020
Severe Behavioral Health Manifestations in Nursing Homes: Associations with Service Availability?
Article in Journal of the American Geriatrics Society, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 12 citations in OpenAlex.
- A systematic review of specialty dementia care units in long-term care settings.International journal of geriatric psychiatry · 2023Pooled it
- Community living center-mental health integration in the Veterans Health Administration: Evaluation of practice patterns.Psychological services · 2026Article
- Long-Stay Nursing Home Residents with Dementia: Telemedicine Mental Health Use during the COVID-19 Pandemic.Journal of the American Medical Directors Association · 2025Observational
- Assisted living residents with dementia: Disparities in mental health services pre and during COVID-19.Journal of the American Geriatrics Society · 2024Article
- Post-acute care transitions and outcomes among Medicare beneficiaries with dementia: Associations with race/ethnicity and dual status.Health services research · 2023Observational
- Serious Mental Illness in Nursing Homes: Stakeholder Perspectives on the Federal Preadmission Screening Program.Journal of aging & social policy · 2022Article
- Reliability and Validity of the Cornell Scale for Depression in Dementia and Invariance Between Black Versus White Residents in Nursing Homes.Journal of the American Medical Directors Association · 2022Article
- Relationship between environmental factors and responsive behaviours in long-term care homes: a secondary data analysis.BMJ open · 2021Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
BACKGROUND/
objectivesDespite high prevalence of behavioral health (BH) manifestations among nursing home (NH) residents, availability of BH services in this care setting is often inadequate. Our objective was to examine associations between availability of BH services and the presence of severe depression, suicidal ideation (SI), and severe aggressive behaviors (ABs) among NH residents.
designCross-sectional. SETTING/
participantsThis study used 2017 survey data about BH service availability obtained from 1,051 NHs. The Minimum Data Set (MDS) was used to identify long-stay residents in these facilities (N = 101,238) and the prevalence of BH manifestations. Descriptive statistics and multivariable logistic regressions were used. MEASUREMENTS: We constructed measures of three severe BH manifestations based on the MDS: presence of depression, SI, and ABs. Three independent measures of service availability based on survey items asked about degrees of inadequate (1) staff BH education, (2) coordination/collaboration between facility/community providers, and (3) facility infrastructure (ie, ability to make referrals/transport residents to services).
resultsOdds of severe depression were 21% higher (odds ratio [OR] = 1.21; P < .001) when NHs reported inadequate BH staff education. Residents with SI had 13% higher odds (OR = 1.13; P = .027) of living in NHs that reported inadequate coordination between facility and community providers. Severe ABs were 10% more likely among residents in NHs reporting inadequate facility infrastructure (OR = 1.10; P = .002) and 7% more likely in facilities with self-reported inadequate coordination between facility/community providers (OR = 1.07; P = .019). Several facility-level factors (eg, staffing, training, turnover) were also statistically significantly associated with these severe BH manifestations.
conclusionResidents in NHs reporting inadequate BH services were more likely to experience adverse severe BH manifestations even after controlling for individual and facility-level risk factors. Higher nurse staffing and more staff psychiatric training were associated with lower prevalence of severe BH manifestations. Policy changes and modifications to Medicaid NH reimbursements may be warranted to better incentivize NHs to improve provision of BH services.
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