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Delirium as a prognostic factor in older medical inpatients with and without dementia
9th congress of the EUGMS / European Geriatric Medicine 4 (2013) S142–S216
Key conclusions.– These results suggest that Souvenaid® is most efficacious in early AD and warrant long-term trials in the early AD process. Souvenaid and Fortasyn are registered trademarks of N.V. Nutricia. Partly funded by NL FND project No. 10003. Funded by the EU F project LipiDiDiet, Grant Agreement No. 211696. http://dx.doi.org/10.1016/j.eurger.2013.07.688 P624
The effectiveness of French origin dementia care method; Humanitude to acute care hospitals in Japan M. Honda a,b , M. Mori a,b , S. Hayashi a,b , K. Moriya a,b , R. Marescotti a,b , Y. Gineste a,b a National Hospital Organization, Tokyo Medical Center, Tokio, Japan b Institut Gineste-Marescotti, France Introduction.– 23.3% of population in Japan is aged over 65 and the prevalence of dementia is estimated to be 33.9% in age over 85. Effective high quality geriatric care is critically needed, while the burn out of nurse has been increasing due to difficulties taking care of dementia patients who are admitted for acute medical problems. Humanitude is a care method widely used for dementia patients in France. Objectives.– To assess the effectiveness of Humanitude. Design.– Qualitative before-and-after study. Methods.– Nurses working at acute care hospitals were trained with 5 days intensive course of Humanitude. The course contained lectures of the philosophy and theory of the methodology, the techniques of care, and clinical practice of bedside care to dementia patients. Throughout the course, 4 pillars of the methodology; how to look, talk, touch and stand up, were repeatedly emphasized. The participants were asked in questionnaires before and after the course. Narrative analysis was performed. Results.– Twenty-three nurses enrolled the study. Pre-course inquiry showed there were difficulties to take care of geriatric patients especially with dementia, while few organized training focusing on dementia care had been provided. The most difficult situation was care for behavioral and psychological symptoms of dementia. Post-course inquiry revealed that the comprehensive care using 4 pillars were considered new and satisfactory technique, and the participants gained confidence of better communication and care for patients. Overall time consumption for care was shortened. Conclusions.– Nurses in acute care hospitals recognized Humanitude is effective in care for geriatric dementia patients. http://dx.doi.org/10.1016/j.eurger.2013.07.689 P625
Observations of symptoms of dying and treatment in the last days before death in dementia patients in long-term care facilities M.S. Klapwijk a,b , M.A.A. Caljouw a , M.C. van Soest-Poortvliet c , J.T. Van der Steen c , W.P. Achterberg a a Department of Public Heath and Primary Care, Leiden University Medical Center, Leiden, The Netherlands b Marente, nursing home van Wijckerslooth, Oegstgeest, The Netherlands c Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Introduction.– Little is known about symptoms of dying and treatment of demented patients in long-term care facilities. Although
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dementia at the end of life is increasingly being studied, we lack observational data on dying patients. We observed symptoms of dying in patients with dementia in the last days before death. Methods.– When the elderly care physicians in two Dutch nursing homes expected death within one week, symptoms of (dis)comfort, pain and suffering were observed twice daily. The Pain Assessment in Advanced Dementia (PAINAD; range 0–10), Discomfort Scale - Dementia of Alzheimer Type (DS-DAT; range 0–27), End-OfLife in Dementia-Comfort Assessment in Dying (EOLD-CAD; range 14–42) and Mini-Suffering State Examination (MSSE; range 0–9), were used. Also data regarding medical treatment were collected. Results.– Twenty-four patients (median age 91; 23 females) were observed several times (mean 4.3 observations [SD 2.6]), until they died. Most (n = 15) died from dehydration/cachexia and passed away quietly (n = 22). The mean PAINAD score was 1.0 (SD 1.7), DSDAT 7.0 (SD 2.1), EOLD-CAD 35.1 (SD 1.7), and MSSE 2.0 (SD 1.7). All participants received morphine, few antibiotics (n = 6) or rehydration (n = 1). No difference in symptomatology was found between the causes of death. Conclusion.– People with advanced dementia showed low levels of discomfort, suffering and number of symptoms in their last days of life, even for people dying from dehydration/cachexia. This relative ‘good’ death was accompanied by active comfort treatment (morphine) and withholding of active and invasive curative treatment. The use of observation tools may help physicians to make treatment decisions. http://dx.doi.org/10.1016/j.eurger.2013.07.690 P626
Delirium as a prognostic factor in older medical inpatients with and without dementia M. del Rocío Malfeito Jiménez , R. Arauz Rivera , M.L. Velasco Prieto , D. Fernandez Mendez , L.A. Negrón Blanco , F. Veiga Fernandez HULA, Lugo, Spain Introduction.– This study aimed to determine the independent effects of delirium in older medical inpatients, with and without dementia, on 6-month mortality and functional prognosis. Method.– A prospective observational study was conducted during six months. Patients admitted to the Acute Geritric Unit were recruited when they met criteria for delirium. The patients were followed up during hospitalization and 6 months later to assess functional and cognitive outcome as well as death. Chi-squared, t-Student test and Mantel-Hensel were used to perform the bivariated analysis. A multivariated COX regression was also carried out, adjusted for age, sex and Charlson comorbidity index, Pvalues < 0.05 were considered statistically significant. Results.– Of 78 participants with delirium (mean age: 87 years), 45 (58%) had dementia. Fifty percent of delirium patients without dementia had a worsening of their functional capacity. Overall mortality was 47%, higher in patients without dementia (56%). The delirium was resolved in 44% and 34% of patients with and without dementia respectively. Multivariate analysis showed that cognitive decline does not represent a significant risk factor for mortality in elderly patients who have delirium (adjusted RR 1.378 [0.406–4.679, CI 95%]). Patients with delirium and dementia have a mean survival at six months of 41.28 days higher than patients without dementia (79.17 [21.29–137.05, 95% CI]) and (37.89 [21.94–53.83, 95% CI]) respectively. Conclusions.– Delirium is an independent predictor of mortality and functional decline. It is a particularly important prognostic marker on mortality and functional decline among patients without dementia. http://dx.doi.org/10.1016/j.eurger.2013.07.691
Key conclusions.– These results suggest that Souvenaid® is most efficacious in early AD and warrant long-term trials in the early AD process. Souvenaid and Fortasyn are registered trademarks of N.V. Nutricia. Partly funded by NL FND project No. 10003. Funded by the EU F project LipiDiDiet, Grant Agreement No. 211696. http://dx.doi.org/10.1016/j.eurger.2013.07.688 P624
The effectiveness of French origin dementia care method; Humanitude to acute care hospitals in Japan M. Honda a,b , M. Mori a,b , S. Hayashi a,b , K. Moriya a,b , R. Marescotti a,b , Y. Gineste a,b a National Hospital Organization, Tokyo Medical Center, Tokio, Japan b Institut Gineste-Marescotti, France Introduction.– 23.3% of population in Japan is aged over 65 and the prevalence of dementia is estimated to be 33.9% in age over 85. Effective high quality geriatric care is critically needed, while the burn out of nurse has been increasing due to difficulties taking care of dementia patients who are admitted for acute medical problems. Humanitude is a care method widely used for dementia patients in France. Objectives.– To assess the effectiveness of Humanitude. Design.– Qualitative before-and-after study. Methods.– Nurses working at acute care hospitals were trained with 5 days intensive course of Humanitude. The course contained lectures of the philosophy and theory of the methodology, the techniques of care, and clinical practice of bedside care to dementia patients. Throughout the course, 4 pillars of the methodology; how to look, talk, touch and stand up, were repeatedly emphasized. The participants were asked in questionnaires before and after the course. Narrative analysis was performed. Results.– Twenty-three nurses enrolled the study. Pre-course inquiry showed there were difficulties to take care of geriatric patients especially with dementia, while few organized training focusing on dementia care had been provided. The most difficult situation was care for behavioral and psychological symptoms of dementia. Post-course inquiry revealed that the comprehensive care using 4 pillars were considered new and satisfactory technique, and the participants gained confidence of better communication and care for patients. Overall time consumption for care was shortened. Conclusions.– Nurses in acute care hospitals recognized Humanitude is effective in care for geriatric dementia patients. http://dx.doi.org/10.1016/j.eurger.2013.07.689 P625
Observations of symptoms of dying and treatment in the last days before death in dementia patients in long-term care facilities M.S. Klapwijk a,b , M.A.A. Caljouw a , M.C. van Soest-Poortvliet c , J.T. Van der Steen c , W.P. Achterberg a a Department of Public Heath and Primary Care, Leiden University Medical Center, Leiden, The Netherlands b Marente, nursing home van Wijckerslooth, Oegstgeest, The Netherlands c Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Introduction.– Little is known about symptoms of dying and treatment of demented patients in long-term care facilities. Although
S207
dementia at the end of life is increasingly being studied, we lack observational data on dying patients. We observed symptoms of dying in patients with dementia in the last days before death. Methods.– When the elderly care physicians in two Dutch nursing homes expected death within one week, symptoms of (dis)comfort, pain and suffering were observed twice daily. The Pain Assessment in Advanced Dementia (PAINAD; range 0–10), Discomfort Scale - Dementia of Alzheimer Type (DS-DAT; range 0–27), End-OfLife in Dementia-Comfort Assessment in Dying (EOLD-CAD; range 14–42) and Mini-Suffering State Examination (MSSE; range 0–9), were used. Also data regarding medical treatment were collected. Results.– Twenty-four patients (median age 91; 23 females) were observed several times (mean 4.3 observations [SD 2.6]), until they died. Most (n = 15) died from dehydration/cachexia and passed away quietly (n = 22). The mean PAINAD score was 1.0 (SD 1.7), DSDAT 7.0 (SD 2.1), EOLD-CAD 35.1 (SD 1.7), and MSSE 2.0 (SD 1.7). All participants received morphine, few antibiotics (n = 6) or rehydration (n = 1). No difference in symptomatology was found between the causes of death. Conclusion.– People with advanced dementia showed low levels of discomfort, suffering and number of symptoms in their last days of life, even for people dying from dehydration/cachexia. This relative ‘good’ death was accompanied by active comfort treatment (morphine) and withholding of active and invasive curative treatment. The use of observation tools may help physicians to make treatment decisions. http://dx.doi.org/10.1016/j.eurger.2013.07.690 P626
Delirium as a prognostic factor in older medical inpatients with and without dementia M. del Rocío Malfeito Jiménez , R. Arauz Rivera , M.L. Velasco Prieto , D. Fernandez Mendez , L.A. Negrón Blanco , F. Veiga Fernandez HULA, Lugo, Spain Introduction.– This study aimed to determine the independent effects of delirium in older medical inpatients, with and without dementia, on 6-month mortality and functional prognosis. Method.– A prospective observational study was conducted during six months. Patients admitted to the Acute Geritric Unit were recruited when they met criteria for delirium. The patients were followed up during hospitalization and 6 months later to assess functional and cognitive outcome as well as death. Chi-squared, t-Student test and Mantel-Hensel were used to perform the bivariated analysis. A multivariated COX regression was also carried out, adjusted for age, sex and Charlson comorbidity index, Pvalues < 0.05 were considered statistically significant. Results.– Of 78 participants with delirium (mean age: 87 years), 45 (58%) had dementia. Fifty percent of delirium patients without dementia had a worsening of their functional capacity. Overall mortality was 47%, higher in patients without dementia (56%). The delirium was resolved in 44% and 34% of patients with and without dementia respectively. Multivariate analysis showed that cognitive decline does not represent a significant risk factor for mortality in elderly patients who have delirium (adjusted RR 1.378 [0.406–4.679, CI 95%]). Patients with delirium and dementia have a mean survival at six months of 41.28 days higher than patients without dementia (79.17 [21.29–137.05, 95% CI]) and (37.89 [21.94–53.83, 95% CI]) respectively. Conclusions.– Delirium is an independent predictor of mortality and functional decline. It is a particularly important prognostic marker on mortality and functional decline among patients without dementia. http://dx.doi.org/10.1016/j.eurger.2013.07.691