- Email: [email protected]
ACUTE OUTPATIENT TREATMENT OF DEMENTED PATIENTS WITH BPSD
P530
Poster Presentations: P2
function, which was assessed using the Mini-Mental State Examination (MMSE), the Symbol Digit Modalities Test (Perceptual Speed), and both immediate and delayed recall of the East Boston Memory Test (Episodic Memory). An index of global cognitive function scores was derived by averaging z-scores of all tests. Logistic regression models were used to assess the association of cognitive function domains and risk for EM. Results: After adjusting for potential confounders, every 1 point decline in global cognitive function (OR, 1.57(1.21-2.03)), MMSE (OR, 1.07(1.03-1.10)), episodic memory (OR, 1.46(1.14-1.86) and perceptual speed (OR, 1.05(1.02-1.07)) scores were associated with increased risk for EM. Lowest tertiles in global cognitive function (OR, 2.71 (1.49-4.88), MMSE (OR, 2.02 (1.07-3.80)), episodic memory (OR, 2.70(1.41-5.16)) and perceptual speed (OR, 4.41 (2.22 -8.76)) scores were associated with increased risk for EM. Conclusions: Decline in global cognitive function, MMSE, and perceptual speed scores were associated with increased risk for EM. P2-162
ACUTE OUTPATIENT TREATMENT OF DEMENTED PATIENTS WITH BPSD
Annette Lolk1, Kjeld Andersen2, 1Institute of Clinical Health, University of Southern Denmark, Odense C, Denmark; 2Institute of Clinical Health, University of Southern Denmark, Odense, Denmark. Contact e-mail: lolk@ dadlnet.dk Background: Behavioral and psychological symptoms of dementia (BPSD) are a heterogeneous group of noncognitive symptoms and behaviors in demented patients. Clinically significant BPSD is seen in nearly 80% of patients living in nursing homes. Treatment for BPSD include various non-pharmacological and pharmacological approaches. The symptoms are very distressing, and demand for prompt intervention. Methods: All consecutive demented patients with BPSD referred to the "acute team for dementia with BPSD" at the Department of Psychiatry in Odense, Denmark, from January 2008 to January 2013 were included. The team consisted of a geriatric psychiatrist and a skilled nurse. Within 48 hours the team contacted the family and/or nursing home staff. A plan for relevant observations by caregivers and a visit to the patient’s home was scheduled. At the first visit a medical history was recorded, and the patient was evaluated using the Neuropsychiatric Inventory (items for psychosis, hallucinations and agitation/aggression) and the Mini Mental State Examination. Based on all the information obtained a plan was made including behavioral interventions and pharmacological treatment. Depending on the course this plan could be adjusted. Results: 319 patients (75% living in nutidig homes) were included. 68 % had Alzheimer’s disease (AD), 8 % vascular dementia, 6 % mixed dementia, and 18 % other forms or unspecified dementia. The score for the three NPI items was 13.2 at the first visit and reduced to 4.5 at the final visit. At the first visit 39 % of the patients with AD or Lewy Body were treated with a cholinesteraseinhibitor and 27 % with memantine. At the final visit these figures were 24 % and 64 %, respectively. 48 % were in treatment with antipsychotics at the beginning and 30 % at the termination. 17 % deceased. Only 4 % were admitted to psychiatric department. Conclusions: It is possible to treat demented patient with BPSD by an outgoing team. Nearly 1/3 of the patients were still in antipsychotic treatment at the termination. This makes demand on the general practitioners to try to withdraw antipsychotics. P2-163
A PROSPECTIVE COHORT STUDY ON MORTALITY RISK ASSOCIATED WITH ATYPICAL ANTIPSYCHOTICS IN PATIENTS WITH ALZHEIMER’S DISEASE: JAPAN CONSORTIUM FOR ANTIPSYCHOTICS TREATMENT IN ALZHEIMER’S DISEASE (J-CATIA)
Heii Arai1, Hiroyuki Kobayashi2, Masamoto Taguchi3, Keita Yamauchi4, Yu Nakamura5, 1Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan; 2Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan; 3 Ohgaki Hospital, Ogaki, Gifu, Japan; 4Graduate School of Health Management, Keio University, Fujisawa City, Kanagawa, Japan;
5 Department of Neuropsychiatry, Faculty of Medicine, Kagawa University, Kagawa, Japan. Contact e-mail: [email protected]
Background: Previous meta-analyses have suggested that the use of antipsychotics for off-label treatment of behavioral disturbances in patients with Alzheimer’s disease (AD) was associated with greater mortality, as the FDA issued a black box warning. However, the greater risk of mortality could be generated only when data on randomized clinical trials were combined in a meta-analysis; there is no conclusive evidence based on prospective studies about the mortality risk associated with the use of antipsychotics. We conducted a large-scale prospective cohort study in Japan to compare 10-week and 24-week mortality risks in AD patients between those who were given antipsychotics and those who were not and to explore risk factors of death associated with the use of antipsychotics. Methods: The study cohort consisted of the patients who were over age 65 and treated as AD in 357 sites throughout Japan on Oct 10 2012, Nov 1st 2012, Nov 20 2012, and Mar 1st 2013. We excluded patients who had severe, unstable, or uncontrolled medical conditions, or were considered to be unlikely to adhere to the study regimens. Patients were followed up for 6 month after registration and all deaths occurring within the 10 weeks and 24 weeks were identified. The study protocol was approved by the ethics committee of Clinical Trial Support Organization in Psycho-Geriatric Field. Results: Of the 10,090 patients enrolled, total data of 9,770 patients were fixed. 70% were female and mean age of the total sample was 82 years old. One third of the patients were inpatients and half of the patients were given antipsychotics at the enrollment. We will report data of the 10-week and 24-week mortality risk associated with the use of antipsychotics. Conclusions: Our findings will provide new evidences about the mortality risk associated with the use of antipsychotics in AD patients. P2-164
FACILITATING PERSON-CENTERED CARE FOR THE PREVENTION OF DELIRIUM IN HOSPITALIZED PERSONS WITH DEMENTIA
Donna Marie Fick1, Jane McDowell2, Lorraine Mion3, Ann Kolanowski4, Brittney DiMeglio2, Erin Kitt-Lewis2, Todd Monroe3, Sharon K. Inouye5, 1 The Pennsylvania State University, University Park, Pennsylvania, United States; 2Penn State, University Park, Pennsylvania, United States; 3 Vanderbilt University, Nashville, Tennessee, United States; 4Penn State University, University Park, Pennsylvania, United States; 5Harvard Medical School, Boston, Massachusetts, United States. Contact e-mail: dmf21@psu. edu Background: Despite the poor outcomes of delirium superimposed on dementia (DSD), intervention studies often exclude or underrepresent persons with dementia, even though the prevalence of DSD is extremely high in both community (13-19%) and hospital (40-89%) populations. The few prospective studies that have been conducted have demonstrated poorer outcomes for patients with DSD compared to delirium alone. Since dementia increases vulnerability to delirium, understanding the role of person-centered care in the prevention of delirium in this vulnerable group is critical. The purpose of this study is to describe how we facilitated person-centered care in the first 4 years of the 5-year END-DSD trial. Methods: The present study is nested within an ongoing 5-year, cluster-randomized, NIH funded clinical trial of multidimensional strategies to improve Early Nurse Detection (and management) of Delirium superimposed on Dementia (END-DSD). The intervention consists of four elements: 1) nursing education; 2) computerized decision support embedded within the electronic health record; 3) a designated unit champion; and 4) weekly rounding sessions facilitated by an advanced practice geriatric nurse. For this study, we conducted qualitative and quantitative analysis of over 700 nurse rounding session forms and family satisfaction surveys regarding person-centered care activities. Results: 394 participants (mean age¼ 83.3 years; 77% female: and 94% Caucasian) have thus far been enrolled in the trial. In preliminary analyses, personcentered care was enhanced in the following areas: minimizing the use of psychoactive medications (documented in 421/715, 58.9% of rounding forms), focusing on individual preferences and unmet needs during rounding (e.g., asking patient music preference, current hobbies, activity and prior occupation), family involvement and satisfaction with the "All About Me
Poster Presentations: P2
function, which was assessed using the Mini-Mental State Examination (MMSE), the Symbol Digit Modalities Test (Perceptual Speed), and both immediate and delayed recall of the East Boston Memory Test (Episodic Memory). An index of global cognitive function scores was derived by averaging z-scores of all tests. Logistic regression models were used to assess the association of cognitive function domains and risk for EM. Results: After adjusting for potential confounders, every 1 point decline in global cognitive function (OR, 1.57(1.21-2.03)), MMSE (OR, 1.07(1.03-1.10)), episodic memory (OR, 1.46(1.14-1.86) and perceptual speed (OR, 1.05(1.02-1.07)) scores were associated with increased risk for EM. Lowest tertiles in global cognitive function (OR, 2.71 (1.49-4.88), MMSE (OR, 2.02 (1.07-3.80)), episodic memory (OR, 2.70(1.41-5.16)) and perceptual speed (OR, 4.41 (2.22 -8.76)) scores were associated with increased risk for EM. Conclusions: Decline in global cognitive function, MMSE, and perceptual speed scores were associated with increased risk for EM. P2-162
ACUTE OUTPATIENT TREATMENT OF DEMENTED PATIENTS WITH BPSD
Annette Lolk1, Kjeld Andersen2, 1Institute of Clinical Health, University of Southern Denmark, Odense C, Denmark; 2Institute of Clinical Health, University of Southern Denmark, Odense, Denmark. Contact e-mail: lolk@ dadlnet.dk Background: Behavioral and psychological symptoms of dementia (BPSD) are a heterogeneous group of noncognitive symptoms and behaviors in demented patients. Clinically significant BPSD is seen in nearly 80% of patients living in nursing homes. Treatment for BPSD include various non-pharmacological and pharmacological approaches. The symptoms are very distressing, and demand for prompt intervention. Methods: All consecutive demented patients with BPSD referred to the "acute team for dementia with BPSD" at the Department of Psychiatry in Odense, Denmark, from January 2008 to January 2013 were included. The team consisted of a geriatric psychiatrist and a skilled nurse. Within 48 hours the team contacted the family and/or nursing home staff. A plan for relevant observations by caregivers and a visit to the patient’s home was scheduled. At the first visit a medical history was recorded, and the patient was evaluated using the Neuropsychiatric Inventory (items for psychosis, hallucinations and agitation/aggression) and the Mini Mental State Examination. Based on all the information obtained a plan was made including behavioral interventions and pharmacological treatment. Depending on the course this plan could be adjusted. Results: 319 patients (75% living in nutidig homes) were included. 68 % had Alzheimer’s disease (AD), 8 % vascular dementia, 6 % mixed dementia, and 18 % other forms or unspecified dementia. The score for the three NPI items was 13.2 at the first visit and reduced to 4.5 at the final visit. At the first visit 39 % of the patients with AD or Lewy Body were treated with a cholinesteraseinhibitor and 27 % with memantine. At the final visit these figures were 24 % and 64 %, respectively. 48 % were in treatment with antipsychotics at the beginning and 30 % at the termination. 17 % deceased. Only 4 % were admitted to psychiatric department. Conclusions: It is possible to treat demented patient with BPSD by an outgoing team. Nearly 1/3 of the patients were still in antipsychotic treatment at the termination. This makes demand on the general practitioners to try to withdraw antipsychotics. P2-163
A PROSPECTIVE COHORT STUDY ON MORTALITY RISK ASSOCIATED WITH ATYPICAL ANTIPSYCHOTICS IN PATIENTS WITH ALZHEIMER’S DISEASE: JAPAN CONSORTIUM FOR ANTIPSYCHOTICS TREATMENT IN ALZHEIMER’S DISEASE (J-CATIA)
Heii Arai1, Hiroyuki Kobayashi2, Masamoto Taguchi3, Keita Yamauchi4, Yu Nakamura5, 1Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan; 2Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan; 3 Ohgaki Hospital, Ogaki, Gifu, Japan; 4Graduate School of Health Management, Keio University, Fujisawa City, Kanagawa, Japan;
5 Department of Neuropsychiatry, Faculty of Medicine, Kagawa University, Kagawa, Japan. Contact e-mail: [email protected]
Background: Previous meta-analyses have suggested that the use of antipsychotics for off-label treatment of behavioral disturbances in patients with Alzheimer’s disease (AD) was associated with greater mortality, as the FDA issued a black box warning. However, the greater risk of mortality could be generated only when data on randomized clinical trials were combined in a meta-analysis; there is no conclusive evidence based on prospective studies about the mortality risk associated with the use of antipsychotics. We conducted a large-scale prospective cohort study in Japan to compare 10-week and 24-week mortality risks in AD patients between those who were given antipsychotics and those who were not and to explore risk factors of death associated with the use of antipsychotics. Methods: The study cohort consisted of the patients who were over age 65 and treated as AD in 357 sites throughout Japan on Oct 10 2012, Nov 1st 2012, Nov 20 2012, and Mar 1st 2013. We excluded patients who had severe, unstable, or uncontrolled medical conditions, or were considered to be unlikely to adhere to the study regimens. Patients were followed up for 6 month after registration and all deaths occurring within the 10 weeks and 24 weeks were identified. The study protocol was approved by the ethics committee of Clinical Trial Support Organization in Psycho-Geriatric Field. Results: Of the 10,090 patients enrolled, total data of 9,770 patients were fixed. 70% were female and mean age of the total sample was 82 years old. One third of the patients were inpatients and half of the patients were given antipsychotics at the enrollment. We will report data of the 10-week and 24-week mortality risk associated with the use of antipsychotics. Conclusions: Our findings will provide new evidences about the mortality risk associated with the use of antipsychotics in AD patients. P2-164
FACILITATING PERSON-CENTERED CARE FOR THE PREVENTION OF DELIRIUM IN HOSPITALIZED PERSONS WITH DEMENTIA
Donna Marie Fick1, Jane McDowell2, Lorraine Mion3, Ann Kolanowski4, Brittney DiMeglio2, Erin Kitt-Lewis2, Todd Monroe3, Sharon K. Inouye5, 1 The Pennsylvania State University, University Park, Pennsylvania, United States; 2Penn State, University Park, Pennsylvania, United States; 3 Vanderbilt University, Nashville, Tennessee, United States; 4Penn State University, University Park, Pennsylvania, United States; 5Harvard Medical School, Boston, Massachusetts, United States. Contact e-mail: dmf21@psu. edu Background: Despite the poor outcomes of delirium superimposed on dementia (DSD), intervention studies often exclude or underrepresent persons with dementia, even though the prevalence of DSD is extremely high in both community (13-19%) and hospital (40-89%) populations. The few prospective studies that have been conducted have demonstrated poorer outcomes for patients with DSD compared to delirium alone. Since dementia increases vulnerability to delirium, understanding the role of person-centered care in the prevention of delirium in this vulnerable group is critical. The purpose of this study is to describe how we facilitated person-centered care in the first 4 years of the 5-year END-DSD trial. Methods: The present study is nested within an ongoing 5-year, cluster-randomized, NIH funded clinical trial of multidimensional strategies to improve Early Nurse Detection (and management) of Delirium superimposed on Dementia (END-DSD). The intervention consists of four elements: 1) nursing education; 2) computerized decision support embedded within the electronic health record; 3) a designated unit champion; and 4) weekly rounding sessions facilitated by an advanced practice geriatric nurse. For this study, we conducted qualitative and quantitative analysis of over 700 nurse rounding session forms and family satisfaction surveys regarding person-centered care activities. Results: 394 participants (mean age¼ 83.3 years; 77% female: and 94% Caucasian) have thus far been enrolled in the trial. In preliminary analyses, personcentered care was enhanced in the following areas: minimizing the use of psychoactive medications (documented in 421/715, 58.9% of rounding forms), focusing on individual preferences and unmet needs during rounding (e.g., asking patient music preference, current hobbies, activity and prior occupation), family involvement and satisfaction with the "All About Me