Year: 2015
Type: article
Study design: Observational Study
Abstract: Although management of dementia and prevention of aggressive behaviors in the inpatient hospital setting are important issues, data on their frequency are lacking. This study provides insight into demographics and begins an exploration of factors related to aggression in this population. Electronic medical records (EMR) of a large public hospital (45,000 discharges/year) were reviewed using the EMERSE search tool. Of the 14,080 adults aged 60+ who spent at least 24 hours at the hospital during the one year study time frame, we examined the EMR of the first 4,000 patients and every 10th person through 14,080 who met these criteria (N=5,008). Ten percent (n=505) had a diagnosed or suspected dementia noted in the record; approximately 25% (n=105) of these had reports of aggressive incidents in their medical record. Sixty-one percent (n=64) of aggression incidents occurred during delirium states. There was no difference in the mean age of the dementia patients compared to the group with aggression (both 78 yo). Those who had incidents of aggression were 49% male (versus 46% of the total group with dementia), 79% white, and 13% black (reflecting the entire sample). Less than one-third of the known dementia patients (n=154) were given cognitive screens to assess their current status. When aggressive behaviors appeared, less than half had a screener attempted to assess current status; if formal assessment of delirium occurred, it was not documented in the EMR, despite the documentation of either rapid decline into classic symptoms or a clinical observation of delirium. It appears that delirium is the leading reason for aggressive behaviors in hospitalized patients with dementia. Our data suggest that demographic differences do not predict aggression, although adequate documentation of dementia diagnoses or cognitive testing conducted were inconsistent in the EMR. Studies suggest that low-cost, nonpharmacological interventions may be the most effective intervention for managing disruptive behaviors and preventing delirium. Hospitals could benefit from implementing such interventions, which would subsequently reduce the incidence of aggressive behaviors and improve hospital effectiveness and efficiency.
Source: Alzheimer s & Dementia
Institutions: University of Central Florida, Michigan Medicine
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2470029408