Psychotropic Drug Consumption at Admission and Discharge of Nursing Home Residents

Rolland, Yves; Andrieu, Sandrine; Crochard, Anne; Goni, Sylvia; Hein, C.; Vellas, Bruno

doi:10.1016/j.jamda.2011.12.056

Cited by 40 publications

(26 citation statements)

References 27 publications

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“…11,12 Transfers are mainly to the ED, with a high rate of ED transfer for older people with dementia. 4,13,14 Underrecognition of dementia can result in poor understanding of a resident's behavior and inappropriate therapy, ultimately leading to an inappropriate care plan. When residents with dementia are hospitalized, they are generally exposed to iatrogenic events and delirium 15 and have a longer hospital stay and greater functional decline than elderly people with similar health conditions but without dementia.…”

Section: Results Of Analysis Of the Secondary End Pointmentioning

confidence: 99%

“…Although systematic screening for dementia in NH residents 1 is recommended by expert groups and by guidelines, underrecognition of the disease has been repeatedly reported in Europe and in the United States 2 and has been identified as an indicator of poor-quality care. 3 Underdiagnosis of dementia has resulted in inappropriate health care [4][5][6][7] and, in particular, a high hospitalization rate, notably emergency department (ED) admissions. However, to our knowledge, the hypothesis that dementia screening in NH residents results in a lower ED transfer rate has never been demonstrated.…”

Section: Introductionmentioning

confidence: 99%

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Systematic Dementia Screening by Multidisciplinary Team Meetings in Nursing Homes for Reducing Emergency Department Transfers

et al. 2020

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IMPORTANCE Dementia is often underdiagnosed in nursing homes (NHs). This potentially results in inappropriate care, and high rates of emergency department (ED) transfers in particular. OBJECTIVE To assess whether systematic dementia screening of NH residents combined with multidisciplinary team meetings resulted in a lower rate of ED transfer at 12 months compared with usual care. DESIGN, SETTING, AND PARTICIPANTS Multicenter, cluster randomized trial with NHs as the unit of randomization. The IDEM (Impact of Systematic Tracking of Dementia Cases on the Rate of Hospitalization in Emergency Care Units) trial took place at 64 public and private NHs in France. Recruitment started on May 1, 2010, and was completed on March 31, 2012. Residents who were aged 60 years or older, had no diagnosed or documented dementia, were not bedridden, had lived in the NH for at least 1 month at inclusion, and had a life expectancy greater than 12 months were included. The residents were followed up for 18 months. The main study analyses were completed on October 14, 2016. INTERVENTION Two parallel groups were compared: an intervention group consisting of NHs that set up 2 multidisciplinary team meetings to identify residents with dementia and to discuss an appropriate care plan, and a control group consisting of NHs that continued their usual practice. During the inclusion period of 23 months, all residents of participating NHs who met eligibility criteria were included in the study. MAIN OUTCOMES AND MEASURES The primary end point (ED transfer) was analyzed at 12 months, but the residents included were followed up for 18 months. RESULTS A total of 64 NHs participated in the study and enrolled 1428 residents (mean [SD] age, 84.7 [8.1] years; 1019 [71.3%] female): 599 in the intervention group (32 NHs) and 829 in the control group (32 NHs). The final study visit was completed by 1042 residents (73.0%). The main reason for early discontinuation was death (318 residents [22.7%]). The intervention did not reduce the risk of ED transfers during the 12-month follow-up: the proportion of residents transferred at least once to an ED during the 12-month follow-up was 16.2% in the intervention group vs 12.8% in the control group (odds ratio, 1.32; 95% CI, 0.83-2.09; P = .24). CONCLUSIONS AND RELEVANCE This study failed to demonstrate that systematic screening for dementia in NHs resulted in fewer ED transfers. The findings do not support implementation of (continued) Key Points Question Does systematic dementia screening of nursing home residents combined with multidisciplinary team meetings result in a lower rate of emergency department transfer compared with usual care? Findings In this cluster randomized clinical trial that included 1428 residents in 64 nursing homes, 16.2% of residents in the intervention group were transferred to emergency departments vs 12.8% in the control group during the 12-month follow-up, a nonsignificant difference. Meaning This study does not suggest that systematic screening for dementia in all nursing home resid...

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Section: Results Of Analysis Of the Secondary End Pointmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Systematic Dementia Screening by Multidisciplinary Team Meetings in Nursing Homes for Reducing Emergency Department Transfers

et al. 2020

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“…It is not surprising that these factors are associated with increased risk of admission or readmission from PAC. (41–46) In addition to severity of illness and comorbidities, patient and caregiver goals of care (including do-not-resuscitate orders) are highly predictive of hospital readmission from a PAC setting. (44; 47) For example, O’Malley found that the presence of advanced directives increased the time between hospitalization among nursing home patients.…”

Section: Interventions For Patients Discharged To Post-acute Care Facmentioning

confidence: 99%

“…(43; 55) For example, antipsychotic medications initiated in the acute care setting for agitated delirium are often continued without indication and potentially increase the risk for rehospitalization. (43; 46; 56) In addition, care should be made to minimize the use of urinary catheters, peripherally inserted central catheters (PICC lines), and other indwelling devices at the time of discharge, as these present potential safety hazards and increased risk of rehospitalization. (55; 57; 58) Finally, patients transitioning to PAC facilities should be included in routine advanced care planning discussions.…”

Section: Interventions For Patients Discharged To Post-acute Care Facmentioning

confidence: 99%

Reducing Hospital Readmission Rates: Current Strategies and Future Directions

et al. 2014

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New financial penalties for institutions with high readmission rates have intensified efforts to reduce rehospitalization. Several interventions that involve multiple components (e.g., patient needs assessment, medication reconciliation, patient education, arranging timely outpatient appointments, and providing telephone follow-up), have successfully reduced readmission rates for patients discharged to home. The effect of interventions on readmission rates is related to the number of components implemented, whereas single-component interventions are unlikely to reduce readmissions significantly. For patients discharged to post-acute care facilities, multicomponent interventions have reduced readmissions through enhanced communication, medication safety, advanced care planning, and enhanced training to manage common medical conditions that commonly precipitate readmission. To help hospitals direct resources and services to patients with greater likelihood of readmission, a number of risk stratification methods are available. Future work should better define the role of home-based services, information technology, mental health care, caregiver support, community partnerships, and new transitional care personnel.

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“…However, the data vary between countries and data sources. Studies using health insurance claims data reported that 54% of nursing home residents with dementia in France [9] and 40% in the United States [10] received acetylcholinesterase inhibitors or memantine. Primary data on the prevalence of antidementia drug treatment in community dwelling PWD in Germany is lacking.…”

Section: Introductionmentioning

confidence: 99%

Antidementia Drug Treatment in People Screened Positive for Dementia in Primary Care

Wucherer

Eichler

Kilimann

et al. 2015

JAD

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Psychotropic Drug Consumption at Admission and Discharge of Nursing Home Residents

Cited by 40 publications

References 27 publications

Systematic Dementia Screening by Multidisciplinary Team Meetings in Nursing Homes for Reducing Emergency Department Transfers

Systematic Dementia Screening by Multidisciplinary Team Meetings in Nursing Homes for Reducing Emergency Department Transfers

Reducing Hospital Readmission Rates: Current Strategies and Future Directions

Antidementia Drug Treatment in People Screened Positive for Dementia in Primary Care

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