title: Measuring change in clinical profiles between hospital admission and discharge and predicting living arrangements at discharge for aged patients presenting behavioral and psychological symptoms of dementia.
abstract: The clinical courses of psychogeriatric inpatients presenting behavioral and psychological symptoms of dementia, between their admission and discharge, have been poorly documented. Based upon our previously elaborated profiles of psychogeriatric patients, this study aimed to describe these courses and to explore whether changing clinical profiles could predict living arrangements at discharge.
  
  
  
  Retrospective data were collected on 397 patients with dementia and hospitalized from 2011 to 2014 in French-speaking Switzerland. Patients were classified on admission and at discharge using four clinical profiles (BPSD-affective, BPSD-functional, BPSD-somatic, and BPSD-psychotic). Multinomial logistic regression analyses were used to identify predictors of living arrangements at discharge. Age, gender, marital status, living arrangements on admission, and clinical profile on admission and discharge, were used as potential predictors.
  
  
  
  Of the patients classified as BPSD-functional or BPSD-affective on admission, 70.18% and 73.48%, respectively, had the same classification at discharge. However, 45.74% of patients classified as BPSD-somatic on admission were discharged with a BPSD-functional profile, and 46.15% of inpatients classified as BPSD-psychotic on admission were discharged as BPSD-affective (χ(2)(9)=128.8299; p<0.000). At discharge, 64.99% of all patients were admitted to a nursing home. The significant predictors of return to home were: being male (OR=0.96; 95% CI: 0.93-0.99) and BPSD-affective profile (OR=1.95; 95% CI: 1.08-3.54. Significant predictors of transfer to acute care or death were: BPSD-somatic (OR=12.98; 95% CI: 1.96-85.91) or BPSD-psychotic profile (OR=13.53; 95% CI: 1.65-111.05).
  
  
  
  This study provides new information concerning the clinical course of older psychogeriatric inpatients using profiles derived from clinically sensitive profiles.
authors.affiliation: Institute of Higher Education and Research in Health (IUFRS), Faculty of Biology and Medicine, University of Lausanne and Lausanne University Hospital, Route de la Corniche 10, 1010 Lausanne, Switzerland. Electronic address: claudia.ortoleva-bucher@chuv.ch.
authors.forename: Claudia Ortoleva
authors.initials: CO
authors.lastname: Bucher
authors.affiliation: Research Centre on Aging, Sherbrooke University Institute of Geriatrics, 1036 Rue Belvédère S, Sherbrooke, QC J1H 4C4, Canada; School of Nursing, Faculty of Medicine and Health Sciences, University of Sherbrooke, 2500 Boulevard de l'Université, Sherbrooke, QC J1K 2R1, Canada.
authors.forename: Nicole
authors.initials: N
authors.lastname: Dubuc
authors.affiliation: Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Route du Mont, 1008 Prilly, Switzerland.
authors.forename: Armin
authors.initials: A
authors.lastname: von Gunten
authors.affiliation: Institute of Higher Education and Research in Health (IUFRS), Faculty of Biology and Medicine, University of Lausanne and Lausanne University Hospital, Route de la Corniche 10, 1010 Lausanne, Switzerland; Faculty of Nursing Sciences, Laval University, 2325 Rue de l'Université, Québec, QC G1V 0A6, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Morin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000145:classification / Q000523:psychology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010351:Patient Discharge; D012189:Retrospective Studies; D012737:Sex Factors; D013557:Switzerland
keywords: Classification; Dementia; Inpatients; Nursing home admission; Prediction