title: Predictors of prolonged hospital stay for the treatment of severe neuropsychiatric symptoms in patients with dementia: a cohort study in multiple hospitals.
abstract: BACKGROUND
  Long hospitalization is often needed to treat severe behavioral and psychological symptoms of dementia (BPSD), which places heavy demands on hospital resources. Consequently, patients with severe BPSD usually wait for a long time to be admitted. There is a need to identify factors related to long hospitalization to better manage resources of a psychiatric hospital.
  
  
  METHODS
  We surveyed 150 consecutive patients hospitalized in the neuropsychiatric units of three hospitals for treatment of BPSD from 11 May 2009 to 30 November 2010. Only patients with reliable relatives were included in the study. We evaluated data of the patients (demographics, cognitive impairment, activities of daily living, causal disease for dementia, dementia severity, and the amount of pension), their primary caregivers (demographics and care burden), and their doctors' years of experience in treating dementia. We followed up to 180 days and assessed the effect of these factors on the length of stay.
  
  
  RESULTS
  Of the 150 patients, 104 were discharged within 180 days and 46 were hospitalized for more than 180 days. Average length of stay for patients was 110.4 ± 58.1 days. In both univariate and multivariate Cox proportional hazard analyses, length of stay was longer for patients with smaller pensions and patients whose doctors had fewer years of experience in treating dementia. Length of stay was not found to be associated with any of the other variables.
  
  
  CONCLUSIONS
  Patients with smaller pensions and whose doctors had less experience in treating dementia tended to require longer hospitalization.
authors.affiliation: Department of Psychiatry, Osaka University Graduate School of Medicine, Suita-City, Osaka, Japan. sugiyama@psy.med.osaka-u.ac.jp
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Sugiyama
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kazui
authors.forename: Kazue
authors.initials: K
authors.lastname: Shigenobu
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Masaki
authors.forename: Naoki
authors.initials: N
authors.lastname: Hatta
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yamamoto
authors.forename: Tamiki
authors.initials: T
authors.lastname: Wada
authors.forename: Keiko
authors.initials: K
authors.lastname: Nomura
authors.forename: Kenji
authors.initials: K
authors.lastname: Yoshiyama
authors.forename: Kaoru
authors.initials: K
authors.lastname: Tabushi
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Takeda
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000175:diagnosis* / Q000191:economics / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008483:Medical Assistance; D008875:Middle Aged; D009483:Neuropsychological Tests; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires