• J Hosp Med · Sep 2022

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

    • Rachel Tannenbaum, Marie Boltz, Anum Ilyas, Valeria Gromova, Suzanne Ardito, Mutahira Bhatti, Gwenyth Mercep, Michael Qiu, Gisele Wolf-Klein, Zaldy S Tan, Jason Wang, and Liron Sinvani.
    • Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA.
    • J Hosp Med. 2022 Sep 1; 17 (9): 702-709.

    BackgroundHospitalized persons living with dementia (PLWD) often experience behavioral symptoms that challenge medical care.ObjectiveThis study aimed to identify clinical practices and outcomes associated with behavioral symptoms in hospitalized PLWD.DesignA retrospective cross-sectional study.Settings And ParticipantsThe study included PLWD (65+) admitted to one of severe health system hospitals in 2019.InterventionBehavioral symptoms were defined as the presence of (1) a psychoactive medication for behavioral symptoms; (2) an order for physical restraints or constant observation; and/or (3) physician documentation of delirium, encephalopathy, or behavioral symptoms.Main Outcome And MeasuresAssociations between behavioral symptoms and patient characteristics and hospital practices (e.g., bladder catheter) were examined. Multivariable logistic/linear regression was used to evaluate the association between behavioral symptoms and clinical outcomes (e.g., mortality).ResultsOf hospitalized PLWD (N = 8637), the average age was 84.5 years (IQR = 79-90), 61.7% were female, 60.1% were white, and 9.4% (n = 833) were Hispanic. Behavioral symptoms were identified in 40.6% (N = 3606) of individuals. Behavioral symptoms were significantly associated with male gender (40.3% vs. 36.9%, p = .001), white race (62.7% vs. 58.3%, p < .001), and residence in a facility prior to admission (26.6% vs. 23.7%, p < .001). Regarding hospital practices, indwelling bladder catheters (11.2% vs. 6.0%, p < .001) and dietary restriction (41.9% vs. 33.8%, p < .001) were associated with behavioral symptoms. In multivariable models, behavioral symptoms were associated with increased hospital mortality (odds ratio [OR]: 1.90, CI95%: 1.57-2.29), length of stay (parameter estimate: 2.10, p < .001), 30-day readmissions (OR: 1.14, CI95%: 1.014-1.289), and decreased discharge home (OR: 0.59, CI95%: 0.53-0.65, p < .001).ConclusionsGiven the association between behavioral symptoms and poor clinical outcomes, there is an urgent need to improve the provision of care for hospitalized PLWD.© 2022 Society of Hospital Medicine.

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