A retrospective study of the behavioural and psychological symptoms of dementia in patients admitted to a Specialist Dementia Care Unit.

Abstract

To explore the nature and severity of behavioural and psychological symptoms of dementia (BPSD) and outcomes for patients admitted to a specialist dementia care unit (SDCU) at a tertiary Australian hospital. This single-centre retrospective study categorised patients into a recognised seven-tiered model of severity of BPSD using a novel tool developed for this study. Descriptive characteristics, pharmacological management, and range and severity of BPSD were examined. There were 125 patients admitted over a two-year period reviewed, with 62% being males and a mean age of 82.4years. Those with high severity BPSD (n=61, 49%) had a longer length of stay (p=0.049), were on a greater number of psychotropic medications on admission (p<0.001) and were more likely to be trialled on a new psychotropic medication (p=0.001). At least five behaviours on admission were demonstrated in 84% of patients. Behaviours were ameliorated with reduction in tier severity at discharge (p<0.005). The mean number of psychotropic medications on admission was not significantly different to discharge (p=0.14). Sixty-seven per cent of patients living independently at admission were discharged to residential care, and 44% in residential care were discharged to a new facility. Multi-disciplinary management led to optimisation of behaviours and overall reduction in BPSD severity. This was achieved without a significant increase in the use of psychotropic medications, highlighting the importance of an individualised approach by a team skilled in the behavioural management of BPSD. The study confirms the high risk of transition to residential care for patients with BPSD.