Hospitalized Dementia Patients Research Articles

Trends of Practice and Research Training for Maintaining the Dignity of Older People with Dementia in Japan

Background: As the Japanese people are increasingly living longer, it is essential to improve the quality of medical care provided to those living with dementia. In 2019, the Guidelines for the Promotion of Dementia Policies were published to improve the system in order to become more centered on people with dementia and their families. We have developed training programmes and systems for person-centered care in acute care hospitals to improve the quality of care for older people with dementia. The purpose of this paper was to review and summarise our research on training and system-building for the care of older people with dementia. Method: A review of our research on training and system-building for the care of older people with dementia was conducted. Results: The following programmes, such as person-centered care training, a dementia nursing practice skills development programme, and delirium training for older patients with dementia using virtual reality and augmented reality for nurses and other professionals, were developed to maintain the dignity of the dementia patients in acute care hospitals. Conclusion: The person-centered care training programmes were effective in improving the quality of clinical care. Digital transformation training was more effective, and it elicited a more effective and empathetic experience. We planned to develop a simulation platform based on the metaverse to further develop the community-comprehensive care system, including multidisciplinary collaboration on changes in the place of care for older people with dementia.

Alzheimer's disease pathology: pathways between chronic vascular risk factors and blood-brain barrier dysfunction in a cohort of patients with different types of dementia.

Blood brain barrier (BBB) breakdown is considered a potential mechanism of dementia. The Alzheimer's disease (AD) biomarkers and vascular factors are also associated with BBB permeability. In the present study, the combination effects of neuropathological biomarkers of AD and chronic vascular risk factors for BBB were investigated. The cerebrospinal fluid (CSF)/serum albumin ratio (Qalb), an indicator of BBB permeability, was measured in a total of 95 hospitalized dementia patients. The demographics, clinical information, and laboratory tests were collected from the inpatient records. The CSF neuropathological biomarkers of AD and apolipoprotein E (APOE) genotype were also collected. The mediation analysis model was used to calculate the associations among neuropathological biomarkers of AD (mediator), the Qalb, and chronic vascular risk factors. Three types of dementia, AD (n = 52), Lewy body dementia (LBD, n = 19), and frontotemporal lobar degeneration (n = 24), were included with a mean Qalb of 7.18 (± 4.36). The Qalb was significantly higher in dementia patients with type 2 diabetes mellitus (T2DM, p = 0.004) but did not differ based on the presence of APOE ε4 allele, CMBs, or amyloid/tau/neurodegeneration (ATN) framework. The Qalb was negatively associated with the levels of Aβ1-42 (B = -20.775, p = 0.009) and Aβ1-40 (B = -305.417, p = 0.005) and positively associated with the presence of T2DM (B = 3.382, p < 0.001) and the levels of glycosylated hemoglobin (GHb, B = 1.163, p < 0.001) and fasting blood glucose (FBG, B = 1.443, p < 0.001). GHb is a direct chronic vascular risk factor for higher Qalb (total effect B = 1.135, 95% CI: 0.611-1.659, p < 0.001). Ratios of Aβ1-42/Aβ1-40 or t-tau/Aβ1-42 were mediators of the association between the Qalb and GHb; the direct effect of GHb on the Qalb was 1.178 (95% CI: 0.662-1.694, p < 0.001). Glucose exposure can directly or indirectly affect BBB integrity through Aβ and tau, indicating glucose affects BBB breakdown and glucose stability plays an important role in dementia protection and management.

Assessment and Coping Bahavior of Nurses to Aggressive Behavior of Dementia Patients in Long-term Care hospital

Assessment and Coping Bahavior of Nurses to Aggressive Behavior of Dementia Patients in Long-term Care hospital

Anti-cholinergic drug burden in patients with dementia increases after hospital admission: a multicentre cross-sectional study

BackgroundAnticholinergic medications are drugs that block cholinergic transmission, either as their primary therapeutic action or as a secondary effect. Patients with dementia may be particularly sensitive to the central effects of anticholinergic drugs. Anticholinergics also antagonise the effects of the main dementia treatment, cholinesterase inhibitors. Our study aimed to investigate anticholinergic prescribing for dementia patients in UK acute hospitals before and after admission.MethodsWe included 352 patients with dementia from 17 UK hospital sites in 2019. They were all inpatients on surgical, medical or Care of the Elderly wards. Information about each patient’s medications were collected using a standardised form, and the anticholinergic drug burden of each patient was calculated with an evidence-based online calculator. Wilcoxon’s rank test was used to look at the correlation between two subgroups upon admission and discharge.ResultsOn admission to hospital, 37.8% of patients had an anticholinergic burden score ≥ 1 and 5.68% ≥3. On discharge, 43.2% of patients with an anticholinergic burden score ≥ 1 and 9.1% ≥3. The increase in scores was statistically significant (p = 0.001). Psychotropics were the most common group of anticholinergic medications prescribed at discharge. Of those patients taking cholinesterase inhibitors, 44.9% were also prescribed anticholinergic medications.ConclusionsOur cross-sectional, multicentre study found that people with dementia are commonly prescribed anticholinergic medications, even if concurrently taking cholinesterase inhibitors, and are significantly more likely to be discharged from hospital with a higher anticholinergic burden than on admission.

Gender differences in outpatients with dementia from a large psychiatric hospital in China

BackgroundThe sociodemographic characteristics and clinical features of dementia patients in psychiatric hospitals have not been thoroughly studied in China. This study aimed to explore the psychiatric outpatient attendance of dementia patients at a psychiatric hospital in China, with particular emphasis on gender differences.MethodsThis retrospective study examined outpatients with dementia from January 2013 to August 2019 using data in the Observational Medical Outcomes Partnership Common Data Model (OMOP-CDM) in Beijing Anding Hospital. Age, sex, number of visits, use of drugs and comorbid conditions were extracted from medical records.ResultsNine thousand four patients were recruited from a specific outpatient clinic of a hospital in Beijing, and the mean number of visits was 6.92. There were 3,433 (38.13%) male patients and 5,571 (61.87%) female patients. The most common comorbidities were generalized anxiety disorder, nonorganic insomnia, delusional disorder and depressive disorder. The proportion of patients using antidementia was the highest, with the rate of 68.3%, followed by benzodiazepines (48.83%), antipsychotics (45.43%), antidepressants (22.24%) and nonbenzodiazepines (19.96%). Patients with dementia showed a significant gender difference in average age (t = 6.36, P < 0.0001). Compared to male patients, female patients had a higher number of visits (7.40 ± 12.90 vs 6.15 ± 10.50, t = 4.81, P < 0.0001). There were significant differences in comorbidity composition between male and female patients (t = 23.09, P < 0.0001).ConclusionsOur present findings suggested significant gender differences in the proportion of age, number of visits and comorbidity composition in outpatients with dementia.

Physical restraint of dementia patients in acute care hospitals during the COVID-19 pandemic: A cohort analysis in Japan.

The coronavirus disease (COVID-19) pandemic has caused unprecedented challenges for the medical staff worldwide, especially for those in hospitals where COVID-19-positive patients are hospitalized. The announcement of COVID-19 hospital restrictions by the Japanese government has led to several limitations in hospital care, including an increased use of physical restraints, which could affect the care of elderly dementia patients. However, few studies have empirically validated the impact of physical restraint use during the COVID-19 pandemic. We aimed to evaluate the impact of regulatory changes, consequent to the pandemic, on physical restraint use among elderly dementia patients in acute care hospitals. In this retrospective study, we extracted the data of elderly patients (aged > 64 years) who received dementia care in acute care hospitals between January 6, 2019, and July 4, 2020. We divided patients into two groups depending on whether they were admitted to hospitals that received COVID-19-positive patients. We calculated descriptive statistics to compare the trend in 2-week intervals and conducted an interrupted time-series analysis to validate the changes in the use of physical restraint. In hospitals that received COVID-19-positive patients, the number of patients who were physically restrained per 1,000 hospital admissions increased after the government's announcement, with a maximum incidence of 501.4 per 1,000 hospital admissions between the 73rd and 74th week after the announcement. Additionally, a significant increase in the use of physical restraints for elderly dementia patients was noted (p = 0.004) in hospitals that received COVID-19-positive patients. Elderly dementia patients who required personal care experienced a significant increase in the use of physical restraints during the COVID-19 pandemic. Understanding the causes and mechanisms underlying an increased use of physical restraints for dementia patients can help design more effective care protocols for similar future situations.

Discordance between the perceptions of clinicians and families about end-of-life trajectories in hospitalized dementia patients.

Due to the unpredictable dementia trajectory, it is challenging to recognize illness progression and the appropriateness of a palliative approach. Further confusion occurs during hospitalization where the presence of comorbid conditions complicates prognostication. This research examined clinicians and families' perceptions of dementia as a terminal condition in relation to end-of-life admissions. The study was based in the General Medicine units of one Australian public hospital. Medical, nursing, and social work clinicians were recruited to reflect multidisciplinary perspectives. Bereaved caregivers of deceased patients with dementia were interviewed 3 months following death. Qualitative research underpinned by a social constructionist epistemology and framed through complex systems theory. Semi-structured interviews generated data that illuminated perceptions of deterioration observed toward the end of life. Although participants anticipated general cognitive and physical deterioration associated with dementia, the emergence of comorbid illness made it difficult to predict the onset of the end of life. During a hospital admission, clinicians attributed the end of life to the advanced outcomes of dementia, whereas families described new medical crises. End-of-life admissions illuminated intersections between dementia and comorbidities rather than illness progression. In contrast with the perception that people with dementia lose awareness at the end of life, families drew attention to evidence that their loved one was present during the dying phase. Our findings challenge the dominant understanding of dementia trajectories. Bifurcations between clinicians and families' views demonstrate the difficulties in recognizing end-of-life transitions. Implications for the integration of palliative care are considered.

Discontinuation of antipsychotics treatment for elderly patients within a specialized behavioural unit: a retrospective review.

Background Best practice guidelines recommend regular evaluation of antipsychotics in managing behaviours for dementia patients with a view to de-prescribing, given its significant mortality and adverse outcomes (Reus et al. in Am J Psychiatry 173(5):543-546, 2016, Deprescribing Guidelines and Algorithms in https://deprescribing.org/resources/deprescribing-guidelines-algorithms/ , 2019). The relationship between the dose of antipsychotic and the probability of discontinuation remains unknown in hospitalized dementia patients. Objectives This study aims to examine the relationship between high dose antipsychotic (greater than 62mg chlorpromazine equivalent daily dose) and antipsychotics discontinuation in hospitalized dementia patients. Setting Specialized Dementia Behavioral Health Program in Hamilton, Ontario, Canada. Method A retrospective chart review was completed from August to December of 2019. A univariate logistic regression model was applied to antipsychotic doss (in chlorpromazine equivalent) and antipsychotic discontinuation outcome at 60days (Narayan and Nishtala in Eur J Clin Pharmacol 73(12):1665-1672, 2017). A multivariant model was used to assess potential confounders, including other psychiatric medication exposure and Medicines Comorbidity Index (Luthra in J Gerontol Geriatr Res 4(260):2, 2015). Regression and dose-response models were utilized to identify the threshold dose (maximum daily dose). Main outcome measures Antipsychotic discontinuation at 60days after the last dose. Results A total of 42 patients were eligible for outcome analysis. High dose antipsychotic was associated with worse discontinuation outcomes in both unadjusted (odds ratio, 0.09; 95% confidence interval, 0.02-0.37; p < 0.01) and adjusted generalized estimation equation models (odds ratio 0.65; 95% confidence interval, 0.59-0.72; p = 0.01). There were no statistically significant associations between baseline comorbidities (Medicines Comorbidity Index) (p = 0.68), mood stabilizer (p = 0.14), benzodiazepines (p = 0.93) and antidepressant exposure (p = 0.68) with antipsychotic discontinuation. The logistic regression model identified 40.7mg of quetiapine, 1.7mg of olanzapine and 0.51mg of risperidone as the threshold dose, balancing sensitivity and specificity. The dose-response model also identified similar doses of 42mg of quetiapine, 1.76mg of olanzapine and 0.53mg of risperidone. Conclusion The use of high dose antipsychotics is associated with worse discontinuation outcomes in hospitalized dementia patients. Therefore, our results suggest not exceeding a daily dose of 50mg of quetiapine, 1.75mg of olanzapine and 0.5mg of risperidone when used for responsive behaviours and reassess the benefits and risks for each patient regularly.

Improving Sleep Disturbance in Hospitalized Dementia Patients.

Sleep disturbance is common in hospitalized dementia patients. Consequences include adverse health outcomes and heavy social and economic costs. Education programs have improved dementia care and outcomes. A quality improvement project designed to improve sleep disturbance in hospitalized dementia patients was piloted on a medical-surgical unit of an urban, Midwestern hospital. Nurses and nursing assistants received education on evidence-based interventions to improve sleep disturbance in dementia patients. Pre-/posttests measured changes in staff knowledge. Sleep logs measured changes in hours of patient sleep. Mean test scores increased for nurses from pre- to posttest. Sleep-wake tracking showed increased hours of sleep over time, but small sample sizes precluded pre- and posteducation statistical comparisons. Education programs can increase nurses' knowledge of evidence-based sleep disturbance care for dementia patients. Larger sample sizes are needed to determine whether such programs can significantly improve their sleep.

Continuity of Hospital Care and Feeding Tube Use in Cognitively Impaired Hospitalized Persons.

Hospitalists are increasingly the attending physician for hospitalized patients, and the scheduling of their shifts can affect patient continuity. For dementia patients, the impact is unknown. Longitudinal study using physician billing claims between 2000 and 2014 to examine the association of continuity of care with the insertion of a feeding tube (FT). US hospitals. Between 2000 and 2014, 166,056 hospitalizations of patients with a prior nursing home stay, advanced cognitive impairment, and impairments in four or more activities of daily living (mean age = 84.2 years; 30.4% male; 81.0% white). Continuity of care measured at the hospital level with the Sequential Continuity Index (SECON; range = 0 to 100; higher score indicates higher continuity). Rates of a hospitalist acting as the attending physician increased from 9.6% in 2000 to 22.6% in 2010, whereas a primary care physician with a predominant outpatient focus acting as the attending physician decreased from 50.3% in 2000 to 12.6% in 2014. Post-2010, a mixture of physician specialties increased from 55.5% to 66.4% with a reduction in hospitalists from 22.6% (2010) to 14.1% (2013). Continuity of care decreased over time with SECON dropping from 63.0 to 43.5. Adjusting for patient baseline risk factors, a nonlinear association was observed between SECON and FT insertion. Using cubic splines in the multivariate logistics regression model, the risk of FT insertion in hospitals where the SECON score dropped from 82 to 23 had an adjusted risk ratio (ARR) of FT insertion of 1.48 (95% confidence interval [CI] = 1.34-1.63); hospitals in which SECON dropped from 51 to 23 had an ARR of FT insertion of 1.38 (95% CI = 1.27-1.50). Hospitalized dementia patients in hospitals in which continuity of care was lower had higher rates of FT insertions. Newer models of care are needed to enhance care continuity and thus ensure treatment consistent with likely outcomes of care and goals of care. J Am Geriatr Soc 68:1852-1856, 2020.

Interprofessional Work Model for Dementia Care in Hospitals for Community-Based Care

In this manuscript the authors have studied interprofessional work model for dementia care in hospitals for community-based care. As present situations and problems of dementia patients in hospitals for community-based care, 8 core categories (19 categories) were extracted and as actual situations of interprofessional work for dementia care, 8 core categories (13 categories) were obtained. The authors examined a function of interprofessional work model and practice contents using these categories. The results revealed that better interprofessional work can be expected by six specialists of nurses rehabilitation specialists, MSW, pharmacists, dietitians and care workers developing dementia care based on “Family handling function” “ADL maintenance and improved function” “Staff member education and empowerment function”.

Association rule mining of care targets from hospitalized dementia patients from a medical center in Taiwan

Caring for people with dementia is a huge task, and patients with behavioral and psychological symptoms of dementia such as wandering, resistance to care, agitation, and aggression would increase workloads for staffs to take care of patients. It is critically important to provide a comprehensive care for hospitalized patients with dementia. This study uses apriori algorithm to analyze hospitalized patients with dementia in a medical center in Taiwan. Fifty eight patients with the detailed information from the self-built database are the objects. Gender, age, type of dementia, number of days in hospital, and hospital medical expenses are antecedents in apriori algorithm, while fifteen care targets are both antecedents and consequents. With the minimum support of 40%, minimum confidence of 95%, and lift greater than one, twenty one rules are generated. Eight refined generalized rules are further summarized. Seven out of eight rules depict the correlation between or among care targets, while one generalized rule is related to male patients with dementia. The hospital management can bundle those care targets to provide better healthcare for patients with dementia in this case hospital and pay much attention to male patients with dementia for particular care targets in practice.

The Knowledge of Attitudes of Nurses and Doctors caring for Dementia Patients in Hospital

The Aim: The goal of this study was to establish the knowledge and attitudes of nurses and doctors in caring for dementia patients. Methodology: This survey was carried out using self-reporting questionnaires. The setting was a Health Service Executive (HSE) hospital. The hospital was a Level 3 site because it has an Emergency department that is open for admissions 24 hours a day, and is equipped with a Medical Assessment Unit. For this survey, a descriptive approach was adopted. 147 (n=147) health professionals were interviewed (nurses n=100 and doctors n=47) through the use of a convenience sample. The data was collected using a combination of two questionnaires, both of which were validated and deemed reliable while inclusive of demographics. The two measures used were the Alzheimer’s Disease Knowledge Scale (ADKS) and the Dementia Attitude Scale (DAS). Analysis: Descriptive analysis was undertaken for all variables using the computer software Statistical Package for the Social Sciences (SPSS) Version 21. Independent correlation coefficients, T-tests and ANOVA tested the relationships between the participants’ knowledge, attitudes, and characteristics in relation to dementia patients. Results: The results show a 70% return rate of completed questionnaires in both the nurse (n=70) and doctor (n=33) groups. Only 30% of participants had received specific education about dementia. Both doctors and nurses had similar scores on the attitude and knowledge scales, which were moderate overall. The DAS suggests that attitudes were moderately positive in both groups. No significant increase in knowledge was found in respondents who had attended previous educational courses. No respondent attended the National Two-Day Dementia Programme. Age was not a significant factor when compared with knowledge and attitudes. A number of participants (n=22) were not interested in furthering their knowledge of dementia. However, this was not significant to the respondents’ overall knowledge and attitudes scores.

Analysis of Western-Korean cooperative treatment in hospital-care of patients with dementia

Objectives : The purpose of this study is to provide data to guide dementia health-care policy in Korea and to establish the position of Korean medical specialists in long-term care hospitals by analyzing the data of dementia inpatients. We analyzed the actual condition of dementia patients in care hospital and the effect of Western-Korean cooperative medicine on the progress of dementia. Methods : From January 1, 2016 to December 31, 2016, inpatients who were diagnosed with dementia at Mungyeong municipal long-term care hospital and admitted for more than 3 months were enrolled. Their medical records and simple tests were analyzed retrospectively. Results : We examined the detailed diagnosis, including both main and sub diagnosis, and Alzheimer disease dementia, at 97%, was the most common. At the time of admission, Korean Version of the Mini-Mental State Exam (K-MMSE) analysis showed that severe dementia affected 52%, and most were rated as Geriatric Depression Scale (GDS) 6. Based on the admission date, the results of a simplified test applied to the dementia patients every 6 months showed an maintain in the K-MMSE and GDS scores in 83%. Conclusion : The results of this study show that the rate of progression of dementia is somewhat lower in inpatients with moderate to severe Alzheimer`s who have received Western-Korean cooperative treatment. However, due to institutional limitations, long-term inpatients such as those with dementia do not receive active traditional Korean medical treatment; hence, it is necessary to improve the national institution of traditional Korean medicine in long-term care hospitals.

Admission of people with dementia to psychiatric hospitals in Japan: factors that can shorten their hospitalizations.

People exhibiting serious behavioural and psychological symptoms of dementia are usually voluntarily or involuntarily committed to psychiatric hospitals for treatment. In Japan, the average hospital stay for individuals with dementia is about 2 years. Ideally, individuals should be discharged once their symptoms have subsided. However, we see cases in Japan where individuals remain institutionalized long after behavioural and psychological symptoms of dementia are no longer apparent. This study will attempt to identify factors contributing to shorter stays in psychiatric hospitals for dementia patients. Questionnaires consisting of 17 items were mailed to 121 psychiatric hospitals with dementia treatment wards in western Japan. Out of 121 hospitals that received the questionnaires, 45 hospitals returned them. The total number of new patient admissions at all 45 hospitals during the month of August 2014 was 1428, including 384 dementia patients (26.9%). The average length of stay in the dementia wards in August 2014 was 482.7 days. Our findings revealed that the rate of discharge after 2 months was 35.4% for the dementia wards. In addition, we found that the average stay in hospitals charging or planning to charge the rehabilitation fee to dementia patients was significantly shorter than in hospitals not charging the rehabilitation fee. In Japan, dementia patients account for over 25% of new admissions to psychiatric hospitals with dementia wards. The average length of stay in a psychiatric hospital dementia ward is more than 1 year. A discharge after fewer than 2 months is exceedingly rare for those in a dementia ward compared with dementia patients in other wards. If institutions focus on rehabilitation, it may be possible to shorten the stay of dementia patients in psychiatric hospitals.

Death of Dementia Patients in Psychiatric Hospitals and Regional Supply of Psychiatric Services: Study of the National Data from 1996 to 2014 in Japan.

Japan designates psychiatric inpatient care for behavior management of individuals with dementia and for helping dementia patients discharge to home. However, there has been no examination of the effectiveness of this strategy. The present study investigated the association between dementia and the discharge destination of patients in psychiatric hospitals. Data from the National Patient Survey, which is a nationally representative cross-sectional survey of inpatient care, were used. The 96,420 patients with dementia or other mental illness who were discharged from psychiatric hospitals in September of every 3 years from 1996 to 2014 were included in analyses. Of the 96,420 discharged patients, 13,823 had dementia as the primary disease. Of the 13,823 dementia patients, 3,865 (28.0%) were discharged to home, 3,870 (28.0%) were admitted to a facility or other care settings, 3,574 (25.9%) were admitted to another hospital, and 2,514 (18.2%) died. Patients were more likely to die in psychiatric hospital if their primary disease was dementia, and they had resided in a region that provided fewer home visits for psychiatric nursing care or had available a larger number of psychiatric hospital beds per capita. Psychiatric inpatient care may be ineffective as a treatment for the challenging behaviors of dementia. A community mental health system for behavior management should be constructed in parallel with a reduction in the number of hospital beds allotted for psychiatric care.

Ethnic Variations in Prognosis of Patients with Dementia: A Prospective Nationwide Registry Linkage Study in The Netherlands.

Data on dementia prognosis among ethnic minority groups are limited in Europe. We assessed differences in short-term (1-year) and long-term (3-year) mortality and readmission risk after a first hospitalization or first ever referral to a day clinic for dementia between ethnic minority groups and the ethnic Dutch population in the NetherlandsMethods: Nationwide prospective cohorts of first hospitalized dementia patients (N = 55,827) from January 1, 2000 to December 31, 2010 were constructed. Differences in short-term and long-term mortality and readmission risk following hospitalization or referral to the day clinic between ethnic minority groups (Surinamese, Turkish, Antilleans, Indonesians) and the ethnic Dutch population were investigated using Cox proportional hazard regression models with adjustment for age, sex, and comorbidities. Age-sex-adjusted short-term and long-term risks of death following a first hospitalization with dementia were comparable between the ethnic minority groups and the ethnic Dutch. Age- and sex-adjusted risk of admission was higher only in Turkish compared with ethnic Dutch (HR 1.57, 95% CI,1.08-2.29). The difference between Turkish and the Dutch attenuated and was no longer statistically significant after further adjustment for comorbidities. There were no ethnic differences in short-term and long-term risk of death, and risk of readmission among day clinic patients. Compared with Dutch patients with a comparable comorbidity rate, ethnic minority patients with dementia did not have a worse prognosis. Given the poor prognosis of dementia, timely and targeted advance care planning is essential, particularly in ethnic minority groups who are mired by cultural barriers and where uptake of advance care planning is known to be low.

Perceptions and Intention of Nurses in Using Physical Restraints for Dementia Patients in Geriatric Hospitals

Purpose The purpose of this study was to investigate nurses' perceptions and intention to use physical restraints for geriatric hospital dementia patients. Methods A cross-sectional study design was used with 112 nurses recruited from 6 geriatric hospitals. Data on nurses' general characteristics as well as perceptions and intention to use physical restraints for dementia patients were collected. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation coefficient and standard multiple regression with SPSS/WIN 21.0. Results There were significant differences in perceptions of physical restraints for dementia patients according to type of restraint (wrist, lapboard with wheelchair, or alternative methods). Significant differences in intention were found for age, position, mobility decline, alternative methods, physical restraints guideline, and complaints from family. Factors affecting nurses' intention to use physical restraints included perceptions on physical restraint use, mobility decline, being a head nurse, and no alternative method available. These factors explained 51% of total variances in the regression model. Conclusion Findings show that nurses' perception of physical restraints for geriatric hospital dementia patients is significantly correlated with intention to use physical restraints. Therefore, provision of periodic training and education on alternatives are necessary to reduce indiscriminate use of physical restraints. 주요어: 인식, 의도, 간호사, 치매, ì‹ ì²´ì  ì–µì œëŒ€ Key Words: Perception, Intention, Nurses, Dementia, Physical restraints

‘FAILURE TO MAINTAIN’ DEMENTIA PATIENTS IN HOSPITAL: A NEW METHOD OF QUALITY OUTCOME MEASUREMENT RELATED TO NURSING CARE

‘FAILURE TO MAINTAIN’ DEMENTIA PATIENTS IN HOSPITAL: A NEW METHOD OF QUALITY OUTCOME MEASUREMENT RELATED TO NURSING CARE

Hypnotics and the Occurrence of Bone Fractures in Hospitalized Dementia Patients: A Matched Case-Control Study Using a National Inpatient Database.

BackgroundPreventing falls and bone fractures in hospital care is an important issue in geriatric medicine. Use of hypnotics is a potential risk factor for falls and bone fractures in older patients. However, data are lacking on the association between use of hypnotics and the occurrence of bone fracture.MethodsWe used a national inpatient database including 1,057 hospitals in Japan and included dementia patients aged 50 years or older who were hospitalized during a period of 12 months between April 2012 and March 2013. The primary outcome was the occurrence of bone fracture during hospitalization. Use of hypnotics was compared between patients with and without bone fracture in this matched case-control study.ResultsOf 140,494 patients, 830 patients suffered from in-hospital fracture. A 1:4 matching with age, sex and hospital created 817 cases with fracture and 3,158 matched patients without fracture. With adjustment for the Charlson comorbidity index, emergent admission, activities of daily living, and scores for level walking, a higher occurrence of fractures were seen with short-acting benzodiazepine hypnotics (odds ratio, 1.43; 95% confidence interval, 1.19–1.73; P<0.001), ultrashort-acting non-benzodiazepine hypnotics (1.66; 1.37–2.01; P<0.001), hydroxyzine (1.45; 1.15–1.82, P=0.001), risperidone and perospirone (1.37; 1.08–1.73; P=0.010). Other drug groups were not significantly associated with the occurrence of in-hospital fracture.ConclusionsShort-acting benzodiazepine hypnotics and ultrashort-acting non-benzodiazepine hypnotics may increase risk of bone fracture in hospitalized dementia patients.