title: Agitation and depression in frail nursing home elderly patients with dementia: treatment characteristics and service use.
abstract: OBJECTIVE
  The authors describe characteristics, treatment, and acute service use associated with agitation and depression in dementia.
  
  
  METHODS
  Authors used retrospective chart review of symptoms, physician-level prescribing, and acute service use over 3 months for 2,487 physically frail older residents, including 1,836 with dementia, (mean age: 79.8 years) in 109 long-term care facilities, describing differences between uncomplicated dementia and three mutually exclusive subgroups of complicated dementia, including dementia with agitation-only, dementia with depression-only, and dementia with mixed agitation and depression.
  
  
  RESULTS
  Compared with the other subgroups, frail elderly patients with dementia complicated by mixed agitation and depression have the highest rate of hospitalization, the greatest number of medical diagnoses, and the greatest medical severity, and they receive the greatest number of psychiatric medications. Depression in dementia (either alone or mixed with agitation) was associated with greater prevalence of pain.
  
  
  CONCLUSIONS
  Dementia complicated by mixed agitation and depression accounts for over one-third of complicated dementia and is associated with multiple psychiatric and medical needs, intensive pharmacological treatment, and use of high-cost services. Research should target this complex, high-risk group to develop appropriate diagnostic criteria and effective treatment interventions.
authors.affiliation: Aging Services Research, New Hampshire-Dartmouth Psychiatric Research Center, Department of Psychiatry, Dartmouth Medical School, Lebanon, NH 03766, USA. stephen.j.bartels@dartmouth.edu
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Bartels
authors.forename: Susan D
authors.initials: SD
authors.lastname: Horn
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Smout
authors.forename: Aricca R
authors.initials: AR
authors.lastname: Dums
authors.forename: Ellen
authors.initials: E
authors.lastname: Flaherty
authors.forename: Judith K
authors.initials: JK
authors.lastname: Jones
authors.forename: Mark
authors.initials: M
authors.lastname: Monane
authors.forename: George A
authors.initials: GA
authors.lastname: Taler
authors.forename: Anne C
authors.initials: AC
authors.lastname: Voss
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000150:complications* / Q000534:rehabilitation; D003865:Major Depressive Disorder / Q000150:complications* / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D016330:Frail Elderly; D006760:Hospitalization; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010146:Pain / Q000150:complications / Q000453:epidemiology; D015995:Prevalence; D011595:Psychomotor Agitation / Q000150:complications* / Q000188:drug therapy*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D011619:Psychotropic Drugs