A follow-up intervention in severely demented patients after discharge from a special Alzheimer acute care unit: impact on early emergency room re-hospitalization rate.
BACKGROUND
Emergency room (ER) re-hospitalizations are prevalent in severe Alzheimer's disease affected older patients.


METHODS
Quasi-experimental before and after study.


METHODS
Discharge of severely demented patients from a Special Alzheimer Acute Care Unit.


METHODS
A total of 390 patients hospitalized in the unit from 2007 through 2009, with at least one of the following characteristics: severe disruptive behavioral and psychological symptoms of dementia (BPSD) (agitation, aggressiveness, and psychotic symptoms), change of living arrangement related to BPSD, exhaustion of the principal caregiver, and discharge of a subject with anosognosia living alone in the community.


METHODS
The intervention consisted of an individualized care plan, targeting the problems observed during the hospital stay, implemented by the means of regular telephone contacts (in the first week after discharge, before the end of the first month, and then at 3 and 6 months) between a geriatric team and the patient's caregiver. Information was gathered on functional decline, BPSD, change of living arrangement and treatment. The calls were followed by a telephone intervention providing advice, support, and information to the caregiver. When required, these calls were followed by a consultation with a physician or psychologist, or by a consultation in the patient's home.


METHODS
The primary outcome measure was the ER re-hospitalization rate, defined as occurring within 31 days of discharge.


RESULTS
The early ER re-hospitalization rate was 8.39% in 2007 versus 8.02% in 2008 (p = 0.818) and 7.47% in 2009 (p = 0.563). Vocal disruptive behavior are more prevalent in re-hospitalized patients (9.64% versus 3.97%, p = 0.05) than in non re-hospitalized patients.


CONCLUSIONS
We found a nonsignificant decrease of early ER re-hospitalization rate at 1 month after discharge. Interventions addressing severe dementia affected patients with BPSD are needed, as this is a major issue in the organization of health care systems.
Department of Geriatric Medicine, Toulouse University Hospital, Toulouse, France.
Hélène
H
Villars
Charlotte
C
Dupuy
Pauline
P
Soler
Virginie
V
Gardette
Maria E
ME
Soto
Sophie
S
Gillette
Fati
F
Nourhashemi
Bruno
B
Vellas
D000359:Aftercare / Q000458:organization & administration; D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000150:complications / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006757:Hospital Units / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*
Alzheimer's disease; behavioral and psychological symptoms of dementia; emergency room re-hospitalization; severe dementia