Page 35 - Delaware Medical Journal - March/April 2021
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TREATMENT
INTRODUCTION
Dementia, recently re-named Major
with independence; however, much of the suffering and expense associated with this disorder’s treatment arises not from the cognitive changes but from associated behavioral and emotional symptoms absent from the disorder’s 1 The umbrella term of behavioral and psychological symptoms of dementia (BPSD) refers to these noncognitive manifestations, which include symptoms such as “disturbed perception, thought content, mood, or behavior that frequently occur in persons with dementia.”2 Characteristic BPSD in people with dementia include delusions, hallucinations, agitation, aggression, apathy, anxiety, depression,
or inappropriate sexual behavior.
Despite the absence of a consensus on
the precise incidence and prevalence
of BPSD, nearly all studies agree that
the majority of persons with dementia
will manifest one or more behavioral
or psychological symptoms during the disorder’s progression. Studies have found the incidence to range from approximately 70% to upwards of 90%.3–11 The emergence of BPSD is often followed by intermittent brief or persistent recurrences, so not only the incidence but also the prevalence of BPSD in persons with dementia is very high.1 Multiple factors are responsible for the broad range of reported prevalence rates, including differences among study populations and the lack of a standardized assessment method for BPSD.
BPSD are of great importance to caregivers, facilities that provide care, and payers for care. BPSD raise the cost of care by requiring more intensive monitoring and intervention at home as
well as by increasing the frequency of emergency room visits, the number and durations of hospitalizations, and the
need for earlier admission to long-term care facilities (LTCFs). In the LTCFs, dementia-associated behavioral symptoms interfere with effective care and threaten the safety of all residents.1, 6, 12–14
In an effort to investigate the care burden imposed by BPSD in Delaware’s LTCFs, where many residents are persons with dementia, we created and disseminated a survey. We asked administrators at each of our state’s LTCFs to share information regarding the presence of BPSD, the characteristics of BPSD occurring in
the facility, the availability of training and treatment resources, and the pharmacologic and non-pharmacologic strategies employed in the management of residents manifesting BPSD. Our objective was to provide evidence that will clarify the nature and degree of BPSD’s importance in Delaware’s LTCFs in order to inform discussions regarding improved management approaches.
METHODS
The study population, consisting of 82 licensed nursing homes and assisted an online list maintained by the Delaware Department of Health and Human Services and consulted by us in July 2020. For administrative reasons, one Veterans Affairs facility was removed from this study population, leaving 81 facilities for us to contact. The Delaware Health Care Facilities Association (DHCFA) and Delaware’s Division
of Services for Aging and Adults
with Physical Disabilities (DSAAPD) encouraged the facilities to participate. An anonymous, voluntary, cross-sectional administrators was created in REDCap.
in the Neuropsychiatric Inventory (NPI), a widely used tool for assessing BPSD.15 The rest of the survey focused on the prevalence and management of these symptoms as well as how COVID-19
has impacted treatment. The survey was reviewed by the Delaware Department
of Health and Human Services and the DHFCA. Participation was voluntary,
and all responding LTCF administrators read and agreed to an informed consent statement at the beginning of the
survey. This study was approved by the ChristianaCare Institutional Review Board. Collected data were evaluated using descriptive statistics, and all results were analyzed in SAS 9.4 (Cary, NC).
RESULTS
Forty-four of the 81 (54.3%) facilities surveyed opened the survey link. Table 1 describes the thirty-eight facilities (46.9% of those contacted) that responded with answers to at least some survey questions. Fully completed surveys were returned by 19 LTCFs, or 23.4% of those contacted.
The geographic distribution of the
distribution of the 81 facilities in Delaware: 19 (50.0%) were located in New Castle and 14 (36.8%) were in Sussex County. The majority of these facilities (55.3%)
are nursing homes and about half of all the responding facilities (52.6%) reported admitting new residents already diagnosed with dementia. Interestingly, the estimated number of persons with dementia (52.2%) in the facilities that accepted new residents with diagnosed dementia was minimally different from the estimated number of persons with dementia (47.3%) in facilities that reported refusal of new residents known to have dementia.
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