Predictors of Discharge Destinations and Three-Month Evolution of Patients Initially Hospitalized in a Cognitive Behavioral Unit

Pongan, Élodie; Dorey, Jean‐Michel; Krolak‐Salmon, Pierre; Fédérico, Denis; Sellier, Claire; Auguste, Nicolas; Fabre, Florence; Laurent, Bernard; Rouch, Isabelle

doi:10.3233/jad-170419

Cited by 9 publications

(4 citation statements)

References 28 publications

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“…Indeed, the duration of admission was significantly longer in patients with anemia and higher inflammatory indexes, which was in line with the results of previous reports [18,19]. In the geriatric field, previous literature has identified other significant predictors of discharge destination such as sex, cognitive disorders, living alone, having a caregiver other than the spouse [20], and independence in the activities of daily living [21]. Therefore, we should consider both socially and medically vulnerable patients as being at a high risk of non-home discharge.…”

Section: Discussionsupporting

confidence: 90%

Association between discharge destination and mid-term mortality in octogenarian patients with ST-elevation myocardial infarction

Yoshioka

Takagi

Morishima

et al. 2021

Journal of Cardiology

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Section: Discussionsupporting

confidence: 90%

Association between discharge destination and mid-term mortality in octogenarian patients with ST-elevation myocardial infarction

Yoshioka

Takagi

Morishima

et al. 2021

Journal of Cardiology

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“…In fact, since literature shows evidence for shortterm effect of the SCU-B, albeit mainly from non-controlled studies as well as from our posthoc analysis of the patients admitted to the unit, the RECage results do not invalidate the "acute" clinical effectiveness of the admission to the SCU-B to solve behavioral crises [30][31][32]. Therefore we think that, where SCU-Bs are available, they should be supported, at least unless there is an available operational alternative [33].…”

Section: Implications For Further Researchmentioning

confidence: 75%

Respectful Caring for the Agitated Elderly (ReCAGE): A Multicentre, Prospective, Observational Study to Evaluate the Effectiveness of Special Care Units for People with Dementia

Mendes,

Bergh,

Cesana

et al. 2023

JAD

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Background: Behavioral and psychological symptoms of dementia (BPSD) bring complexity in the clinical management of people with dementia; therefore, it is important to evaluate different models of care, such as Special Care Units (SCU-B).∥ Objective: To evaluate the SCU-B effectiveness toward alleviating BPSD and improving the quality of life (QoL) of patients and their caregivers.∥ Methods: ReCAGE was a multicenter, controlled, longitudinal study where 508 patients with BPSD were enrolled in two cohorts: 262 patients from centers endowed with a SCU-B, and 246 from centers without SCU-B. Statistical analyses included factorial ANCOVA for comparison among centers. The primary endpoint was effectiveness of the SCU-B, measured through the Neuropsychiatric Inventory (NPI) changes. Secondary endpoints were change in QoL of patients and caregivers, and the tertiary endpoint was time to nursing home admission.∥ Results: The NPI scores decreased in both arms, with a statistically significant difference from baseline to 36 months (p < 0.0001) in both cohorts. Over time, NPI decreased more steeply during the first year in the SCU-B arm, but in the following two years the slope was clearly in favor of the control arm. This different pattern of the two cohorts reached statistical significance at the interaction “cohort by time” (p < 0.0001). Conflicting results were found regarding the outcomes of quality of life, while there were no differences in time to institutionalization in both cohorts.∥ Conclusion: The RECage study did not confirm the long-term superiority of the pathway comprising a SCU-B. A post-hoc analysis revealed data supporting their acute effectiveness during behavioral crises.

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“…A relatively common occurrence of behavioral symptoms among older adults with dementia, its strong association with the risk of institutionalization [ 15 , 19 , 20 ], and the high annual incremental cost of institutionalization [ 16 ] are likely the driving factors for high healthcare expenditures among this patient population. Indeed, according to 2021 estimates, the direct economic burden of dementia from the Center for Medicare and Medicaid Services (CMS) is estimated to be 239 billion USD [ 2 ], and this cost may further increase with the aging population [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of behavioral symptoms as a predictor of institutionalization among Medicaid patients with dementia

Khandker,

Chekani,

Mirchandani

et al. 2023

BMC Geriatr

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Objectives Behavioral symptoms are commonly observed in the course of dementia. This study aimed to assess the association of the diagnosis of a cluster of behavioral symptoms (e.g., agitation, aggression, psychotic symptoms, and delirium/wandering) with the likelihood of subsequent institutionalization. Methods A retrospective cohort study of adults aged 65 and above diagnosed with dementia identified in the IBM® MarketScan® Multistate Medicaid database between October 01, 2015, and September 30, 2019, was conducted. The index date was defined as the first diagnosis date of dementia. The presence or absence of behavioral symptoms was identified in the 6 months prior to the index date (baseline). Institutionalization was evaluated 12 months (follow-up) post the index date. The association between diagnosed behavioral symptoms during the baseline period and institutionalization in the follow-up period was assessed using a multivariable logistic regression, adjusting for baseline sociodemographic and clinical characteristics. Results The study cohort included 40,714 patients with dementia. A diagnosis of behavioral symptoms was found among 2,067 (5.1%) patients during the baseline period. An increased likelihood of institutionalization was found during the follow-up among patients with agitation and aggression in baseline (OR = 1.51 (95% CI: 1.18–1.92)) compared to patients without these symptoms at baseline. Patients with psychotic symptoms in baseline had significantly higher odds of getting institutionalized during the follow-up compared to patients without psychotic symptoms in baseline (OR = 1.36 (95% CI: 1.20–1.54)). Similarly, patients with symptoms of delirium and wandering in baseline had a higher likelihood of institutionalization than patients without these symptoms at baseline (OR = 1.61 (95% CI: 1.30–1.99)). Conclusion Several diagnosed behavioral symptoms were associated with a higher risk of institutionalization among older adults with dementia and should be considered when planning treatment strategies for the effective management of the condition.

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Predictors of Discharge Destinations and Three-Month Evolution of Patients Initially Hospitalized in a Cognitive Behavioral Unit

Cited by 9 publications

References 28 publications

Association between discharge destination and mid-term mortality in octogenarian patients with ST-elevation myocardial infarction

Association between discharge destination and mid-term mortality in octogenarian patients with ST-elevation myocardial infarction

Respectful Caring for the Agitated Elderly (ReCAGE): A Multicentre, Prospective, Observational Study to Evaluate the Effectiveness of Special Care Units for People with Dementia

Diagnosis of behavioral symptoms as a predictor of institutionalization among Medicaid patients with dementia

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