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The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: a longitudinal cohort study.

White, N; Leurent, B; Lord, K; Scott, S; Jones, L; Sampson, EL; (2016) The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: a longitudinal cohort study. International Journal of Geriatric Psychiatry , 31 (6) 10.1002/gps.4463. Green open access

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Abstract

BACKGROUND: The acute hospital is a challenging place for a person with dementia. Behavioural and psychological symptoms of dementia (BPSD) are common and may be exacerbated by the hospital environment. Concerns have been raised about how BPSD are managed in this setting and about over reliance on neuroleptic medication. This study aimed to investigate how BPSD are managed in UK acute hospitals. METHOD(S): A longitudinal cohort of 230 patients with dementia admitted to two acute NHS hospitals. BPSD were measured every four days (Behave-AD scale), as well as documentation of pharmacological prescriptions and non-pharmacological management. RESULTS: The overall prevalence of BPSD was 75%, with aggression and activity disturbance being the most common. Antipsychotics were prescribed for 28 (12%) patients; 70% of these prescriptions were new on admission. Benzodiazepines were prescribed for 27 (12%) patients, antidepressants were prescribed for 37 (16%) patients, and sedatives were prescribed for 14 (3%) patients. Patients who were prescribed antipsychotics, after adjusting for end of life medication, age and dementia severity, were significantly more likely to die (adjusted hazard ratio 5.78, 95% CI 1.57, 21.26, p = 0.008). Non-pharmacological management was used in 55% of participants, most commonly psychosocial interventions (36%) with little evidence of monitoring their effectiveness. A form of restraint was used during 50 (22%) patients' admissions. CONCLUSIONS: Antipsychotic medications and psychosocial interventions were the main methods used to manage BPSD; however, these were not implemented or monitored in a systematic fashion.

Type: Article
Title: The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: a longitudinal cohort study.
Open access status: An open access version is available from UCL Discovery
DOI: 10.1002/gps.4463
Publisher version: http://dx.doi.org/10.1002/gps.4463
Language: English
Additional information: © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Keywords: BPSD, acute hospital, antipsychotics, behaviour, dementia, non-pharmacological management
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/1478263
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