New or Worsening Symptoms and Signs in Community-Dwelling Persons with Dementia: Incidence and Relation to Use of Acute Medical Services.
OBJECTIVE
To understand the range of symptoms that present to family caregivers of community-dwelling persons with Alzheimer's disease and related dementias (ADRD).


METHODS
Six-month longitudinal prospective study to identify the incidence of new or worsening symptoms and their association with acute care medical service use.


METHODS
Community-based sample of volunteers from multiple states.


METHODS
A total of 136 patient-caregiver dyads with a range of dementia severity.


METHODS
Forty four symptoms and signs common in older persons and/or persons with dementia; frequency of emergency department visits, hospitalizations, and death; and associations between reported symptoms and acute medical care.


RESULTS
During a mean of 5.7 months' follow-up, new or worsening organ-specific (90% of participants), nonspecific (89%), and behavioral (88%) symptoms were common, with the average caregiver reporting seven new or worsening symptoms. Most common were worsening confusion (74%), decreased activity (64%), agitation (57%), hallucinations/delusions (45%), voice and speaking problems (45%), not eating or drinking (44%), and stress/anxiety (41%). Hospitalization and emergency department use occurred respectively in 19% and 20% of participants, and were associated with organ-specific symptoms (OR 3.15, P = .02), less so with nonspecific symptoms (OR 2.27, P = .07), and very little with behavioral symptoms (OR 1.44, P = .38). Within each symptom category, certain symptoms were significantly associated with acute medical service use.


CONCLUSIONS
Family caregivers of persons with ADRD must respond to a variety of medical, nonspecific, and behavioral symptoms. The high incidence of new or worsening symptoms and of acute medical care use suggests a need to better target symptom evaluation and management in caregiver education.
Department of Family Medicine, School of Medicine, Denver, Colorado.|Department of Medicine, University of Colorado School of Medicine, Denver, Colorado.
Philip D
PD
Sloane
Department of Medicine, University of Colorado School of Medicine, Denver, Colorado.
Christopher H
CH
Schifeling
Department of Medicine, University of Colorado School of Medicine, Denver, Colorado.|School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Anna S
AS
Beeber
Department of Medicine, University of Colorado School of Medicine, Denver, Colorado.
Kimberly T
KT
Ward
Department of Medicine, University of Colorado School of Medicine, Denver, Colorado.
David
D
Reed
Duke Family Support Program, Duke University, Durham, North Carolina.
Lisa P
LP
Gwyther
Duke Family Support Program, Duke University, Durham, North Carolina.
Bobbi
B
Matchar
Department of Medicine, University of Colorado School of Medicine, Denver, Colorado.|School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Sheryl
S
Zimmerman
D000208:Acute Disease; D000368:Aged; D017028:Caregivers; D003704:Dementia / Q000150:complications*; D005260:Female; D006801:Humans; D015994:Incidence; D057187:Independent Living; D008137:Longitudinal Studies; D008297:Male; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies
community dwelling; comorbidity; dementia; symptoms