Monetary costs of agitation in older adults with Alzheimer's disease in the UK: prospective cohort study

Morris, Stephen; Patel, Nishma; Baio, Gianluca; Kelly, L. A.; Lewis-Holmes, Elanor; Omar, Rumana; Katona, Cornelius; Cooper, Claudia; Livingston, Gill

doi:10.1136/bmjopen-2014-007382

Cited by 50 publications

(36 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The symptoms are persistent (374), so that nearly 40% of those with significant agitation still had symptoms six months later (377) and 60% of those with aberrant motor behaviour on the NPI, such as pacing or doing things repetitively, remained symptomatic 18 months later (373). Caring for an agitated person with dementia is more difficult and time consuming that caring for those without agitation; the additional costs of managing agitation account for around 12% of the costs of dementia (412). Figure 11 outlines approaches to managing agitation in dementia.…”

Section: Agitationmentioning

confidence: 99%

Dementia prevention, intervention, and care

et al. 2017

View full text Add to dashboard Cite

People with dementia are usually older, often have co-morbidities and may need help in coping with these illnesses. A third of older people now die with dementia and all professionals working in endof-life care need to make this a central part of their planning and communication. In this commission, we have detailed evidence-based approaches to dementia and its symptoms. Services should be available, scalable and give value. As there are limited resources, professionals and services need to use what works, not use what is ineffective, and be aware of the difference. Overall, there is good potential for prevention and, once someone develops dementia, for care to be high-quality, accessible, and give value to an under-served, growing population. Effective dementia prevention and care could transform the future for society and vastly improve living and dying for individuals with dementia and their families. Acting now on what we already know can make this difference happen. Key Messages 1 There are increasing numbers of people with dementia globally although incidence in some countries has decreased. 2 Be ambitious about prevention: We recommend energetically treating hypertension in middle aged and older people without dementia to reduce dementia incidence. Interventions for other risk factors, including more childhood education, exercise, maintaining social engagement, reducing smoking, and management of hearing loss, depression, diabetes and obesity; may have the potential of delaying or preventing a third of dementias. 3 Treat cognitive symptoms: To maximise cognition, people with Alzheimer's dementia or Dementia with Lewy Bodies should be offered Cholinesterase Inhibitors (ChEIs)at all stages, or memantine for severe dementia. ChEIs are not effective in Mild Cognitive Impairment. 4 Individualise dementia care: Good dementia care spans medical, social and supportive care, should be tailored to unique individual and cultural needs, preferences, priorities, and should incorporate support for the family carers 5 Care for family carers. Family carers are at high risk of depression. Effective interventions reduce the risk and treat the symptoms, include START (Strategies for Relatives) or REACH (Resources for Enhancing Alzheimer's Caregiver Health intervention) and should be made available. 6 Plan for the future. People with dementia and their families value discussions about the future and decisions about possible attorneys to make decisions. Clinicians should consider capacity to make different types of decisions at diagnosis. 7 Protect people with dementia. People with dementia and society require protection from possible risks of the condition, including self-neglect, vulnerability including to exploitation, managing money, driving or using weapons. Risk assessment and management at all stages of the disease is essential but it should be balanced against the persons' right to autonomy. 8 Manage neuropsychiatric symptoms. Management of the neuropsychiatric symptoms of dementia including agitation, low mood or psyc...

show abstract

Section: Agitationmentioning

confidence: 99%

Dementia prevention, intervention, and care

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Agitation, which is commonly observed in people with dementia (PWD) in nursing homes [1,2,3,4,5], may have many negative impacts on the PWD [6,7,8], their caregivers [9,10,11], and society [12]. Acupressure is a therapy that originates from traditional Chinese medicine (TCM).…”

Section: Introductionmentioning

confidence: 99%

A Randomized Controlled Trial Examining the Effect of Acupressure on Agitation and Salivary Cortisol in Nursing Home Residents with Dementia

Kwan

Leung

Lai

2017

Dement Geriatr Cogn Disord

View full text Add to dashboard Cite

Background: Acupressure has been used to manage agitation in people with dementia because it is safe and inexpensive. However, its effect on agitation and at the biochemical level is uncertain. Methods: This randomized controlled trial examined the effect of acupressure on agitation, as measured by the Cohen-Mansfield Agitation Inventory (CMAI); and on salivary cortisol, as measured at baseline (T0) and in the 3rd (T1), 5th (T2), and 8th (T3) weeks. There were 119 agitated residents with dementia randomized into 3 groups: acupressure (n = 39), sham (n = 41), and usual-care group (n = 39). Results: A downward trend in agitation over time was noted in the acupressure group, which almost reached a level of significance in interaction effects between groups and time points (p = 0.052). Post hoc pairwise tests in the acupressure group showed that acupressure significantly reduced agitation at T2 (mean difference -6.84, 95% CI -10.60, -3.08) compared to baseline. Significant interaction effects between groups and time points were observed on the level of salivary cortisol (p = 0.022). Conclusion: Acupressure is a multicomponent intervention that can reduce agitation. Acupoint activation may not be a significant component in reducing agitation, although this result may have been limited by the inadequate sample size. Acupressure is effective in reducing salivary cortisol in people with dementia.

show abstract

“…The present study focuses on the incremental costs of institutionalization, but agitation may be associated with a much higher overall burden. A study in the United Kingdom estimated that the additional costs of managing agitation accounted for approximately 12% of the costs of dementia or £4091 ($7236) per individual with AD when including additional components such as health care costs [33]. In the US setting, a recent claims‐based retrospective study found that patients with dementia and behavioral disturbances including agitation had a higher prevalence of comorbidities, greater use of comedications, and greater health care utilization, resulting in higher health care costs ($9644) compared with patients with dementia without behavioral disturbances.…”

Section: Discussionmentioning

confidence: 99%

Institutionalization risk and costs associated with agitation in Alzheimer's disease

Cloutier

Gauthier‐Loiselle

Gagnon-Sanschagrin

et al. 2019

A&D Transl Res & Clin Interv

View full text Add to dashboard Cite

IntroductionAgitation in individuals with Alzheimer's disease (AD) may predict institutionalization. This study assessed the incremental risk and costs associated with agitation in individuals with AD.MethodsA retrospective analysis of the National Alzheimer's Coordinating Center Uniform Data Set (June 2005–February 2018) was conducted. Incremental risk of institutionalization associated with agitation was estimated and used with the number of institutionalized individuals with AD and agitation and costs of living by residential setting in the United States (literature-based), to estimate incremental institutionalization costs.ResultsThe analysis included 11,348 individuals with AD: 6603 (58.2%) with and 4745 (41.8%) without agitation. Compared with individuals without agitation, those with agitation were 20% more likely to be institutionalized (odds ratio = 1.20; 95% CI = 1.08–1.33). Total incremental cost of institutionalization associated with agitation was $4.3 billion ($50,588/individual).DiscussionAgitation is associated with a higher risk of institutionalization among patients with AD, which translates into a substantial economic burden.

show abstract

Monetary costs of agitation in older adults with Alzheimer's disease in the UK: prospective cohort study

Cited by 50 publications

References 23 publications

Dementia prevention, intervention, and care

Dementia prevention, intervention, and care

A Randomized Controlled Trial Examining the Effect of Acupressure on Agitation and Salivary Cortisol in Nursing Home Residents with Dementia

Institutionalization risk and costs associated with agitation in Alzheimer's disease

Contact Info

Product

Resources

About