title: The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: a longitudinal cohort study.
abstract: BACKGROUND
  The acute hospital is a challenging place for a person with dementia. Behavioural and psychological symptoms of dementia (BPSD) are common and may be exacerbated by the hospital environment. Concerns have been raised about how BPSD are managed in this setting and about over reliance on neuroleptic medication. This study aimed to investigate how BPSD are managed in UK acute hospitals.
  
  
  METHODS
  A longitudinal cohort of 230 patients with dementia admitted to two acute NHS hospitals. BPSD were measured every four days (Behave-AD scale), as well as documentation of pharmacological prescriptions and non-pharmacological management.
  
  
  RESULTS
  The overall prevalence of BPSD was 75%, with aggression and activity disturbance being the most common. Antipsychotics were prescribed for 28 (12%) patients; 70% of these prescriptions were new on admission. Benzodiazepines were prescribed for 27 (12%) patients, antidepressants were prescribed for 37 (16%) patients, and sedatives were prescribed for 14 (3%) patients. Patients who were prescribed antipsychotics, after adjusting for end of life medication, age and dementia severity, were significantly more likely to die (adjusted hazard ratio 5.78, 95% CI 1.57, 21.26, p = 0.008). Non-pharmacological management was used in 55% of participants, most commonly psychosocial interventions (36%) with little evidence of monitoring their effectiveness. A form of restraint was used during 50 (22%) patients' admissions.
  
  
  CONCLUSIONS
  Antipsychotic medications and psychosocial interventions were the main methods used to manage BPSD; however, these were not implemented or monitored in a systematic fashion.
authors.affiliation: Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK.
authors.forename: Nicola
authors.identifier: http://orcid.org/0000-0002-7438-0072
authors.initials: N
authors.lastname: White
authors.affiliation: Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK.
authors.forename: Baptiste
authors.initials: B
authors.lastname: Leurent
authors.affiliation: Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Lord
authors.affiliation: Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK.
authors.forename: Sharon
authors.initials: S
authors.lastname: Scott
authors.affiliation: Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Jones
authors.affiliation: Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK.|Barnet Enfield and Haringey Mental Health Trust, North Middlesex University Hospital, London, UK.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Sampson
mesh_terms: D000368:Aged; D000374:Aggression; D014150:Antipsychotic Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003704:Dementia / Q000523:psychology / Q000628:therapy; D005260:Female; D006769:Hospitals, General; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015995:Prevalence
chemical_list: D014150:Antipsychotic Agents
keywords: BPSD; acute hospital; antipsychotics; behaviour; dementia; non-pharmacological management