Efficacy of a Geriatrics Team Intervention for Residents in Dementia-Specific Assisted Living Facilities: Effect on Unanticipated Transitions Sandra Bellantonio, MD,Anne M. Kenny, MD, w Richard H. Fortinsky, PhD, w Alison Kleppinger, MS, w Julie Robison, PhD, w Cynthia Gruman, PhD, z Martin Kulldorff, PhD, § and Patricia M. Trella, MS w OBJECTIVES: To determine whether a multidisciplinary team intervention minimizes unanticipated transitions from assisted living for persons with dementia. DESIGN: Randomized trial. SETTING: Two dementia-specific assisted living facilities in Connecticut owned and managed by the same corporation. PARTICIPANTS: One hundred older adults with dementia who relocated to assisted living. INTERVENTION: Four systematic multidisciplinary as- sessments by a geriatrician, geriatrics advanced practice nurse, physical therapist, dietitian, and social worker dur- ing the first 9 months of relocation to assisted living. MEASUREMENTS: Permanent relocation to a nursing fa- cility,emergency department (ED) visits,hospitalization, and death. RESULTS: Fifty-five residents experienced any unantici- pated transition out of assisted living, on average 84 74 daysafter relocation; falls were the primary reason for transition. The intervention reduced the risk of any unan- ticipated transitions (13%), permanentrelocation to a nursing facility (11%), ED visits (12%), hospitalization (45%), and death (63%),but the resultsdid not meet statistical significance. In secondary analysis, more men experienced any unanticipated transition (Po.001), hospi- talization (Po.001), or death (Po.001) than women. CONCLUSION: Although an untargeted multidisciplin- ary intervention did not significantly reduce the risk of transitionsfor individualswith dementia relocating to assisted living in this small sample,trends for decreasing hospitalization and death were found. The data further suggest that those at risk for falls and men may benefit fro targeted clinical interventions to prevent unanticipated transitions, especially during the first 3 months after relo- cation. J Am Geriatr Soc 56:523–528, 2008. Key words: dementia; assisted living; multidisciplinary team care D ementia currently affects more than 4 million persons nationwide, 1 and projected increases in life expectan- cy will cause a substantial rise in prevalence. Most persons with dementia will eventually require assistance with ac- tivities ofdaily living (ADLs)and supervision to ensure safety. Dementia-specific assisted living is an alternative t nursing facility care: care thatmay be required with an increase in functional decline. Assisted living staff provide assistance with ADLs and coordination of medical care, bu the type and extent of direct medical care provided in as- sisted living is highly variable. Medical, functional, and be- havioral problems are all associated with transitions from assisted living. 2–5 If overlooked, or ignored,these clinical symptoms could lead to a medical condition necessitating transition from assisted living. Such transfers may not be adequately anticipated or managed in the ‘‘nonmedical’’ setting of assisted living, especially in persons with demen tia, who often manifest atypical presentations of illness su as a change in mental status and falls and may have diffi- culty verbalizing their needs. Attention to potentially trou- blesome clinical symptomsfrom a geriatric perspective mightpreventunanticipated transitions from dementia- specific assisted living facilities. Accordingly, a randomized trial of a multidisciplinary geriatric team intervention tar- geted at minimizing unanticipated transitions from assiste living for persons with dementia was initiated. This article reports on the primary outcomes of interest:permanent relocation to a nursing facility, emergency department (ED visits, hospitalizations, and death. Address correspondence to Anne Kenny, MD, Center on Aging, MC-5215, University of Connecticut Health Center, Farmington, CT 06030. E-mail: kenny@uchc.edu DOI: 10.1111/j.1532-5415.2007.01591.x From the Baystate Medical Center/Tufts University School of Medicine, Springfield, Massachusetts; w Center on Aging, University of Connecticut, Farmington, Connecticut; z Mathematica Policy Research, Inc., Washington, District of Columbia; § Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts. JAGS 56:523–528, 2008 r 2008, Copyright the Authors Journal compilation r 2008, The American Geriatrics Society 0002-8614/08/$15.00