A multicomponent unit-based approach for hospital care of older adults with behavioral and psychological symptoms of dementia.

Abstract

Persons with Alzheimer's disease and related dementias (ADRD) are more frequently hospitalized and often experience behavioral and psychological symptoms of dementia (BPSD). This study describes a dementia-focused medical unit that aims to improve the management of BPSD in hospitalized patients with ADRD. The objective of the present paper is to: (1) describe the dementia-focused medical unit; (2) describe the population admitted to the dementia-focused medical unit; (3) present management strategies of BPSD prior to and post unit transfer; and (4) describe patient (e.g., mobility, goals-of-care, mortality) and hospital metrics (e.g. LOS, 30-day hospital readmission) for the unit. The remainder of the abstract is the same. A 10-bed dementia-focused medical unit was created in a large academic center in New York. The unit consisted of geographic cohorting, dementia care education for staff (e.g., de-escalation, redirection), and environmental modifications (e.g., common area). An interprofessional team conducted daily rounds that focused on the 4Ms (mobility, mentation, matters most, and medication management), and early discharge planning. A total of 165 hospitalized patients were admitted to the dementia-focused medical unit between July 1, 2024, and October 28, 2024. The mean age of patients was 84.7 years old (SD = 9.0); 67.9% (n = 112) had a documented history of dementia, of which 96.4% (n = 108) had at least moderate dementia (FAST stage 6A+). A comparison of BPSD management before and after transfer demonstrated a significant reduction in constant observation (30.9% vs. 0.0%, p < .001), benzodiazepines (13.3% vs. 6.7%, p = .035), and "as-needed" antipsychotics (29.7% vs. 20.0%, p = .009). While as-needed antipsychotics decreased, there was an increase in scheduled antipsychotics (18.2% vs. 28.5%, p < .001), indicating a shift from reactive to proactive medication management. There is an urgent need to improve the management of BPSD in hospitalized older adults with ADRD. Dementia-focused medical units are an innovative strategy that requires further investigation.