Two-year follow-up study of patients with dementia in an NHS continuing care unit

Dilini Jayalath,Kunle Ashaye,Kuttalingam Shankar

doi:10.1192/pb.bp.112.039834

Abstract

Aims and methodThis is a longitudinal, observational prospective study carried out in a 50-bedded dementia care unit. Fifty patients who had been assessed in 2009 as part of an earlier study were reassessed 2 years later.ResultsAll patients had a diagnosis of dementia, with Alzheimer's dementia being the most common. By 2011, 23 (46%) patients reviewed in 2009 were deceased. We found that there was a reduction in psychotic symptoms in patients 2 years later despite none of them being on antipsychotics. The most common problems on follow-up were apathy, agitation and aggression, irritability and anxiety.Clinical implicationsOur findings support the view of the need to regularly review patients with dementia who have psychotic symptoms that require antipsychotics, as long-term treatment may not be required or beneficial in light of known adverse side-effects.

Highlights

We found that there was a reduction in psychotic symptoms in patients 2 years later despite none of them being on antipsychotics
This study reviewed aspects of the outcome of care for 50 patients in a National Health Service continuing care unit diagnosed with dementia who had been assessed in an earlier study in 2009
All patients who were alive at the time of follow-up in 2011 were no longer on antipsychotic medication

Summary

Results

In our previous study conducted in 2009, there were 50 patients in the unit consisting of 26 males and 24 female patients. There were no significant differences between the patients in the unit in 2009 and 2011 in terms of their ages, gender distribution and duration of dementia (Table 1). There were no significant differences between the mean ages, duration of diagnosis, CDR score and initial total NPI scores of those patients who were deceased at the follow-up compared with those who were still alive (Table 2). In comparing the proportion of patients on antipsychotic medication with those who were not at the time of the initial assessment in 2009, analysis using the chi-squared test revealed no significant difference in their outcome in terms of survivability. Patients in 2009, n Age in 2009, years: mean (s.d.) Duration of diagnosis in 2009, years: mean (s.d.) Total Neuropsychiatric Inventory score in 2009, mean Patients with Clinical Dementia Rating severe rating in 2009, n (%) On antipsychotics in 2009, n (%). There was an increase in the use of memantine from 1 patient (2%) in 2009 to 4 patients (8.3%) in 2011 and a slight increase in use of cholinesterase inhibitors from 3 (6%) in 2009 to 4 patients (8.3%) in 2011

Method

Discussion