Page 34 - Delaware Medical Journal - March/April 2021

Cause for Concern:
Behavioral and Psychological Symptoms of Dementia in Delaware’s Long-Term Care Facilities
Steven J. Banko;
Cecelia Harrison, MPH; Jennifer Rittereiser, MPH; Claudine Jurkovitz, MD, MPH; James M. Ellison, MD, MPH
Acknowledgment: This work was partly supported by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under grant number U54-GM104941 (PI: Gregory Hicks) as well as grant number P20 GM103446 and the State of Delaware.
Introduction: Much of the suffering and expense associated with treatment of persons with dementia (Major Neurocognitive Disorder) arises from associated noncognitive behavioral and psychological symptoms
of dementia (BPSD). Although a consensus on the prevalence of BPSD is lacking, evidence suggests that most people with dementia will manifest one or more
of these symptoms during the disorder’s progression. BPSD raise the cost of care by leading to more frequent emergency room visits, more and longer hospitalizations, and earlier admission to long-term care facilities (LTCF). Treatment of BPSD presents a stressful challenge in LTCFs. We sought to investigate the care burden of BPSD in Delaware’s LTCFs and to gather data that can inform management approaches.
Methods: Using REDCap, we created an anonymous cross-sectional survey designed for completion by LTCF administrators. The Delaware Health Care Facilities Association (DHCFA) and Delaware’s Division of Services for Aging and Adults with Physical Disabilities (DSAAPD) encouraged participation. A link to the survey was emailed to the administrators of 81 facilities in Delaware. The resulting data were evaluated using descriptive statistics.
Results: Forty-four of the 81 facilities surveyed opened the survey link. Thirty-eight facilities answered at
least some of the questions, and 19 surveys were
fully completed. The reported average prevalence of BPSD among Delaware LTCF residents with dementia was 49.3% (SD 28.9). The five most frequently reported BPSD symptoms were anxiety, agitation, wandering, dysphoria/depression, and appetite/
eating abnormalities. All facilities reported employing
a spectrum of pharmacologic and non-pharmacologic management strategies. Twenty-two of 24 respondents (91.7%) reported that behavioral health consultation was available at their facilities and 18 of 20 respondents (90.0%) indicated that they provided training on how to manage residents with BPSD.
Conclusion: BPSD are a pervasive concern among Delaware’s LTCFs. LTCFs may benefit from the development of training programs and dissemination
of treatment guidelines incorporating evidence–based interventions and their implementation in managing BPSD to improve care, decrease stress on residents and caregivers, and reduce some avoidable health care costs.
82 Del Med J | March/April 2021 | Vol. 93 | No. 2
Abstract