Predictors of home discharge among patients hospitalized for behavioural and psychological symptoms of dementia

Abstract

Background The Japanese government recently announced the ‘Five‐Year Plan for Promotion of Measures Against Dementia (Orange Plan)’ to promote people with dementia living in their communities. To achieve this, it is imperative that patients hospitalized with behavioural and psychological symptoms of dementia (BPSD) are helped to return to their own homes. The aim of the present study was to identify predictors of home discharge among patients hospitalized for BPSD. Methods A single‐centre chart review study was conducted on consecutive patients hospitalized from home between April 2006 and March 2011 for the treatment of BPSD. The frequency of discharge back to home was examined in relation to a patient's active behavioural problems and demographics at the time of admission. Diagnoses of dementia were made on the basis of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies. Results In all, 391 patients were enrolled in the study. Of these patients, 163 (42%) returned home. Multiple logistic regression analysis identified high Mini‐Mental State Examination and Nishimura‐style senile activities of daily living scores as significant independent predictors of home discharge. In contrast, living alone and manifestation of aggressiveness at the time of admission were negatively associated with home discharge. Conclusions Few patients hospitalized for BPSD are discharged home, and this number is affected by a patient's clinical and demographic characteristics at the time of admission. These findings should be considered in designing and implementing optimal management and care strategies for patients with BPSD.

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“…However, in stroke patients, no difference in discharge disposition was found between patients with/without dementia . Contributors to nursing home admissions in people with dementia include poor, uncoordinated hospital care, noncognitive symptoms of dementia (eg, depression, agitation, and delusions), and aggression as part of BPSD . Discharge planning should include considering the patient's wishes and using multidisciplinary‐informed standards for discharge from hospital to a care home, although in an audit, consent to a change in residence was not recorded in >30% of patients, nor evidence of “best interests” decision making where patients lacked capacity .…”

Effectiveness of treatment in wards for patients with dementia and issues associated with this treatment: A prospective analysis

“…Second, the professional caregiver burden at admission might reflect the family caregiver burden before admission, and this burden before admission might lead to refusal of a discharge to home. Previous study showed that the agitation is the most common burden of the nursing staff (Zwijsen et al, 2014), and the severer agitation was associated with the longer stay at hospital (Tochimoto, Kitamura, Hino, & Kitamura, 2015). Since the agitation was one of the most common BPSD in the current study, the caregiver burden might be high.…”

Protein-protein interactions underlying the behavioral and psychological symptoms of dementia (BPSD) and Alzheimer’s disease

“…The severity of BPSD increases significantly with disease progression, and BPSD affect the quality of life of both patients and their caregivers [5][6][7]. Though memory deficits are the best studied aspects of AD, it is BPSD that are often the greatest source of burden for patients and caregivers and are one of the main reasons for institutionalization [8][9][10][11]. Along with there being few rigorous studies of BPSD's biochemical and cellular mechanisms, there are no FDA-approved treatments for BPSD management [12,13].…”