Volume 69, Issue 12 p. 3623-3630
Ethnogeriatrics and Special Population

Disproportionate increases in schizophrenia diagnoses among Black nursing home residents with ADRD

Shekinah A. Fashaw-Walters PhD,

Corresponding Author

Shekinah A. Fashaw-Walters PhD

Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA

Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island, USA

Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA

Correspondence

Shekinah A. Fashaw-Walters, PhD, Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware St SE MMC 729 Mayo, Minneapolis, MN 55455, USA

Email: safw@umn.edu

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Ellen McCreedy PhD,

Ellen McCreedy PhD

Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island, USA

Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA

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Julie P. W. Bynum MD, MPH,

Julie P. W. Bynum MD, MPH

Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA

Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA

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Kali S. Thomas PhD, MA,

Kali S. Thomas PhD, MA

Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island, USA

Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA

Center of Innovation in Long-Term Services and Supports, U.S. Department of Veterans Affairs Medical Center, Providence, Rhode Island, USA

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Theresa I. Shireman PhD,

Theresa I. Shireman PhD

Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island, USA

Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA

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First published: 30 September 2021
Citations: 1
See related editorial by Rhodes

Funding information: Agency for Healthcare Research and Quality, Grant/Award Number: 4T32 HS000011; National Institute on Aging, Grant/Award Number: 2P01AG027296-11; Veterans Affairs Health Services Research and Development Service, Grant/Award Number: CDA 14-422

Abstract

Background

Previous research demonstrated an increase in the reporting of schizophrenia diagnoses among nursing home (NH) residents after the Centers for Medicare & Medicaid Services National Partnership to Improve Dementia Care. Given known health and healthcare disparities among Black NH residents, we examined how race and Alzheimer's and related dementia (ADRD) status influenced the rate of schizophrenia diagnoses among NH residents following the partnership.

Methods

We used a quasi-experimental difference-in-differences design to study the quarterly prevalence of schizophrenia among US long-stay NH residents aged 65 years and older, by Black race and ADRD status. Using 2011–2015 Minimum Data Set 3.0 assessments, our analysis controlled for age, sex, measures of function and frailty (activities of daily living [ADL] and Changes in Health, End-stage disease and Symptoms and Signs scores) and behavioral expressions.

Results

There were over 1.2 million older long-stay NH residents, annually. Schizophrenia diagnoses were highest among residents with ADRD. Among residents without ADRD, Black residents had higher rates of schizophrenia diagnoses compared to their nonblack counterparts prior to the partnership. Following the partnership, Black residents with ADRD had a significant increase of 1.7% in schizophrenia as compared to nonblack residents with ADRD who had a decrease of 1.7% (p = 0.007).

Conclusions

Following the partnership, Black NH residents with ADRD were more likely to have a schizophrenia diagnosis documented on their MDS assessments, and schizophrenia rates increased for Black NH residents with ADRD only. Further work is needed to examine the impact of “colorblind” policies such as the partnership and to determine if schizophrenia diagnoses are appropriately applied in NH practice, particularly for black Americans with ADRD.