Hospital practices and clinical outcomes associated with behavioral symptoms in persons with dementia

Tannenbaum, Rachel; Boltz, Marie; Ilyas, Anum; Gromova, Valeria; Ardito, Suzanne; Bhatti, Mutahira; Mercep, Gwenyth; Qiu, Michael; Wolf‐Klein, Gisele; Tan, Zaldy S.; Wang, Jason; Sinvani, Liron

doi:10.1002/jhm.12921

Cited by 6 publications

(16 citation statements)

References 37 publications

(136 reference statements)

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“…The complications of behavioral symptoms, including the development of hospital-acquired conditions such as falls and pressure ulcers, acute malnutrition, dehydration, and aspiration pneumonia, 6,9,10 have become an increasing focus for quality initiatives. 69,70 Consequently, behavioral symptoms are a relevant and meaningful clinical target for intervention in DSD care.…”

Section: Discussionmentioning

confidence: 99%

“…During hospitalization emergence of behavioral symptoms are common in persons with delirium, an acute confusional state ("acute brain failure") with incidence ranging from 11% to 42% in medical patients. 7,9,19,20 Other intrinsic risk factors for delirium include advanced age, being male, higher comorbidity, impaired physical function, and lower education. [19][20][21][22][23][24] Older adults with dementia have 5 times the risk of developing delirium when hospitalized.…”

Section: Behavioral Symptoms In Delirium Superimposed On Dementiamentioning

confidence: 99%

“…In addition, approximately three-quarters of hospitalized persons with dementia display a heterogeneous group of non-cognitive disturbances and behaviors, designated by the International Psychogeriatrics Association as behavioral and psychological symptoms of dementia (BPSD) 6–8. BPSD include agitation, aggression, depression, anxiety, apathy, hallucinations, and sleep disturbance, and are associated with accelerated functional and cognitive impairment, falls, increased resource consumption, and mortality 6–10. Although the clinical term is BPSD, these behavioral symptoms are now more commonly termed “changes in behavior” or “behavioral manifestations of distress,” underscoring the suffering of the person demonstrating these behaviors 11,12.…”

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confidence: 99%

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Delirium and Behavioral Symptoms in Persons With Dementia at Hospital Admission

Boltz

Kuzmik

BeLue

et al. 2023

Alzheimer Disease &Amp; Associated Disorders

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Background: Hospitalized persons with dementia are at risk of delirium with behavioral symptoms, predisposing them to a higher rate of complications and caregiver distress. The purpose of this study was to examine the relationship between delirium severity in patients with dementia upon admission to the hospital and the manifestation of behavioral symptoms, and to evaluate the mediating effects of cognitive and physical function, pain, medications, and restraints.Methods: This descriptive study used baseline data from 455 older adults with dementia enrolled in a cluster randomized clinical trial that tested the efficacy of family centered function-focused care. Mediation analyses were conducted to determine the indirect effect of cognitive and physical function, pain, medications (antipsychotics, anxiolytics, sedative/hypnotics, narcotics, and number of medications), and restraints on behavioral symptoms, controlling for age, sex, race, and educational level. Results:The majority of the 455 participants were female (59.1%), had an average age of 81.5 (SD = 8.4), were either white (63.7%) or black (36.3%), and demonstrated one or more behavioral symptoms (93%) and delirium (60%). Hypotheses were partially supported in that physical function, cognitive function, and antipsychotic medication partially mediated the relationship between delirium severity and behavioral symptoms. Conclusion:This study provides preliminary evidence identifying antipsychotic use, low physical function, and significant cognitive impairment as specific targets for clinical intervention and quality improvement in patients with delirium superimposed on dementia at hospital admission.

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Section: Discussionmentioning

confidence: 99%

Section: Behavioral Symptoms In Delirium Superimposed On Dementiamentioning

confidence: 99%

mentioning

confidence: 99%

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Delirium and Behavioral Symptoms in Persons With Dementia at Hospital Admission

Boltz

Kuzmik

BeLue

et al. 2023

Alzheimer Disease &Amp; Associated Disorders

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“…Thirteen clinically rich covariates were used for propensity score matching (PSM): (1) age; (2) sex; (3) race (Asian, Black, White, other [including American Indian or Alaska Native, Native Hawaiian or Pacific Islander, or multiracial], or unknown), (4) ethnicity (Hispanic or Latino vs not Hispanic or Latino); (5) residential setting prior to hospital admission; (6) history of Parkinson disease; (7) Charlson Comorbidity Index without the age component; (8) previous history of dysphagia; (9) severity of illness as measured by the Modified Early Warning Score; (10) admitting respiratory diagnosis; (11) baseline life-sustaining treatment preferences (defined as do-not-resuscitate orders placed within 24 hours of admission); (12) use of respiratory device on admission (eg, noninvasive positive pressure ventilation); and (13) presence of delirium in the emergency department . Race and ethnicity were included in the analysis to account for potential differences in outcomes (eg, mortality) based on race or ethnicity.…”

Section: Methodsmentioning

confidence: 99%

Thick Liquids and Clinical Outcomes in Hospitalized Patients With Alzheimer Disease and Related Dementias and Dysphagia

Makhnevich,

Perrin,

Talukder

et al. 2024

JAMA Intern Med

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ImportanceOropharyngeal dysphagia is common in hospitalized patients with Alzheimer disease and related dementias (ADRD). Although the use of thick liquids in patients with dysphagia has been shown to reduce aspiration on direct visualization, there is no clear evidence that this practice translates into improved clinical outcomes.ObjectivesTo determine whether a diet of thick liquids compared with thin liquids is associated with improved outcomes in hospitalized patients with ADRD and dysphagia.Design, Setting, and ParticipantsThis cohort study included adults aged 65 years and older with ADRD who were admitted to the medicine service across 11 diverse hospitals in New York between January 1, 2017, and September 20, 2022, with clinical suspicion of dysphagia during hospitalization and survival for at least 24 hours after hospital arrival. Patients were grouped according to whether at least 75% of their hospital diet consisted of a thick liquid diet or a thin liquid diet. Propensity score matching was used to balance covariates across the 2 groups for the following covariates: demographics (eg, age, sex), baseline clinical characteristics (eg, Charlson Comorbidity Index), and acute presentation (eg, respiratory diagnosis, illness severity, delirium).Main Outcomes and MeasuresHospital outcomes included mortality (primary outcome), respiratory complications (eg, pneumonia), intubation, and hospital length of stay (LOS).ResultsOf 8916 patients with ADRD and dysphagia included in the propensity score matched analysis, the mean (SD) age was 85.7 (8.0) years and 4829 were female (54.2%). A total of 4458 patients receiving a thick liquid diet were matched with 4458 patients receiving a thin liquid diet. There was no significant difference in hospital mortality between the thick liquids and thin liquids groups (hazard ratio, 0.92; 95% CI, 0.75-1.14]; P = .46). Compared with patients receiving thin liquids, patients receiving thick liquids were less likely to be intubated (odds ratio [OR], 0.66; 95% CI, 0.54-0.80), but they were more likely to have respiratory complications (OR, 1.73; 95% CI, 1.56-1.91).Conclusions and RelevanceThis cohort study emphasizes the need for prospective studies that evaluate whether thick liquids are associated with improved clinical outcomes in hospitalized patients with ADRD and dysphagia.

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“…BPSD consist of behaviors including agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, and wandering. Despite its high prevalence, BPSD during hospitalization remains largely unexplored (Sampson et al, 2014;Tannenbaum et al, 2022;White et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Reducing Behavioral and Psychological Symptoms of Dementia in Acutely Ill Patients via Patient Engagement Specialists: A Pilot Feasibility Study

Sinvani,

Strunk,

Ardito

et al. 2023

Gerontology and Geriatric Medicine

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Behavioral and psychological symptoms of dementia (BPSD) are common in hospitalized persons living with dementia (PLWD). This pilot aimed to test the feasibility of an innovative model of care, PES-4-BPSD (a dementia unit staffed with Patient Engagement Specialists, PES). Non-randomized pilot feasibility trial was conducted, enrolling N = 158 patients to the intervention unit ( n = 79, a 10-bed dementia unit, staffed with nursing assistants, NAs, with mental health backgrounds, PES) and an enhanced control unit ( n = 79, 40-bed medicine unit, staffed with NAs). All NAs/PES ( N = 63) received dementia training, with completion rate of 82.5%. Overall, patients had ~1 NPI-Q (Neuropsychiatric Inventory Questionnaire) assessment/48 hr. 97% ( n = 153) of PLWD exhibited at least one behavior. Average NPI-Q scores did not differ across intervention (5.36) and control (3.87) units ( p = .23). Patients on the intervention unit had 88% ( p = .002) shorter duration of constant observation. A dementia care unit staffed by PES is an innovative model requiring further research.

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Hospital practices and clinical outcomes associated with behavioral symptoms in persons with dementia

Abstract: Background: Hospitalized persons living with dementia (PLWD) often experience behavioral symptoms that challenge medical care.

Cited by 6 publications

References 37 publications

Delirium and Behavioral Symptoms in Persons With Dementia at Hospital Admission

Delirium and Behavioral Symptoms in Persons With Dementia at Hospital Admission

Thick Liquids and Clinical Outcomes in Hospitalized Patients With Alzheimer Disease and Related Dementias and Dysphagia

Reducing Behavioral and Psychological Symptoms of Dementia in Acutely Ill Patients via Patient Engagement Specialists: A Pilot Feasibility Study

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