demented patients treated in the psychiatric ward of a japanese general hospital
TRANSCRIPT
Poster Presentations P2 S333
Physical Therapy Service, ‘‘Sion Yokohama’’ Facilities for Health Activities
for the Aged, Yokohama, Japan. Contact e-mail: [email protected]
Background: The prevalence of Alzheimer’s disease (AD) is rapidly in-
creasing among Japanese elderly. Behavioral and psychological symptoms
of dementia (BPSD) are a common behavioral symptoms associated with
AD and increase caregiver’s burden. In this study, we examined the effects
of bright light exposure on BPSD in AD patients with institutionalized el-
derly and caregiver’s burden. Methods: Subjects were 8 AD patients
(mean [SD] age, 80 [10.0] years) living in geriatric healthcare facilities for
the aged. BPSD was measured continuously over 3 weeks using CMAI (Co-
hen-Mansfield Agitation Inventory) and NPI-NH (Neuropsychiatric Inven-
tory-Nursing Home Version) by caregivers and occupational therapists.
Cognitive performance was assessed by MMSE (Mini-Mental State Exami-
nation) at the end of each week. Caregiver’s burden was alse assessed by J-
ZBI (Modified Japanese Version of the Zarit Caregiver Burden Interview) at
the end of each week. In the second week, subjects received either white
(12,000K) or orange (2,400K) light about 2000 lux from light-emitting di-
odes, measured before the eyes in gaze direction, from 9:00 am to 9:30 am
during occupational therapy. Differences of variables between weeks were
assessed using ANOVA with multiple comparisons (P < 0.05). Results:
As the results, scores for NPI-NH and CMAI were significantly (P < 0.05)
decreased in both orange (2,400K) and white (12,000K) light sessions. Dur-
ing the second and third weeks, scores for NPI-NH and CMAI significantly
(P < 0.05) decreased compared with the first week. However, scores for
MMSE and J-ZBI did not change over 3 weeks. Conclusions: These results
suggest that BPSD symptoms were improved by bright light exposure in
the morning. Bright light might have a modest benefit in improving BPSD
symptoms.
P2-069 THE USE OF DRUGS IN DEMENTED AND NON-
DEMENTED PEOPLE ACCORDING TO LIVING
SITUATION; A COMPARISON BETWEEN RURAL
AND URBAN AREASdRESULTS FROM SNAC,
A POPULATION-BASED MULTICENTER STUDY
Anders B. Skoldunger, Britt-Marie Sjolund, Kristina Johnell,
Anders Wimo, Karolinska Institutet, Stockholm, Sweden.
Contact e-mail: [email protected]
Background: The increasing number of elderly people is an intriguing
challenge for the health care and social support system. Dementia is
one of the major reasons for disability and use of drugs in old age. The
aim of the study was to identify differences in drug use for demented
and non demented according to their living situation between a rural
and an urban area. Methods: Data was gathered from two sites participat-
ing in the Swedish National Study on Aging and Care (SNAC), a longitu-
dinal population based cohort study that started in 2001 including people
60 years and older. Nordanstig is a rural municipality in the middle of
Sweden and Kungsholmen is an urban district of Stockholm.. The amount
of drug use was based on self-reported (or proxy reported in case of de-
mentia) prescription. Results: At baseline (2001-2003) slightly more
drugs in total were reported in the area of Kungsholmen (4.3%) than in
Nordanstig (2.8) (p < 0.01) . The proportion using sedatives was lower
in Nordanstig (11.8%) than in Kungsholmen (23.8%) (p < 0.01). Antide-
pressive drugs was used in Nordanstig by 9.1% and in Kungsholmen
11.9% of the population. Nordanstig had a bigger proportion of demented
people (10.2%) than Kungsholmen(7.5%) (p < 0.05). Demented people
lived to a greater extent in institution (58.6%) than non-demented
(41.4%) (p < 0.01). Antidementia drugs were used by less than 1% of
those with dementia in Nordanstig and by 1.3% in Kungsholmen (p ¼0.15) . A greater proportion of demented people had more than 3 drugs
(64.0%) than non-demented (p < 0.01) in the rural area . In the urban
area the demented with more than 3 drugs accounted for 62.9% (p <
0.01)of the population. Conclusions: The rural area had greater propor-
tion of demented but nevertheless had a lower prescription of drugs which
indicates complex structures of comorbidity, care organization and other
factors influencing prescription.
P2-070 DEMENTED PATIENTS TREATED IN THE
PSYCHIATRIC WARD OF A JAPANESE GENERAL
HOSPITAL
Masafumi Yoshimura, Hiroyuki Oda, Tatsuya Sugimoto,
Keiichiro Nishida, Aran Tajika, Yoshiteru Takekita, Misa Suzuki,
Toshihiko Kinoshita, Kansai Medical University, Moriguchi, Osaka, Japan.
Contact e-mail: [email protected]
Background: The number of Japanese psychiatric beds in general hospitals
has been decreasing in recent years. It has been decreasing at the rate of
12.1% per five years from 2002 (21,732 beds) to 2007 (19,103 beds). The
proportion of psychiatric beds in general hospital to psychiatric beds in psy-
chiatric hospital was only 5.4%. The lack of the psychiatric beds in general
hospital matters because there are many demented patients with behavioral
and psychological symptoms who suffered somatic disease which needs hos-
pitalization. Therefore, we explored the current situation of demented pa-
tients who treated in the psychiatric ward of a general hospital referring to
the psychiatric ward (39 beds) which belongs to our institute. Methods:
We examined demographic and clinical background of patients who dis-
charged in 2008. In total, 165 patients (43 male, 122 female) with mean
(6 SD) age of 50.8 (6 16.6) years discharged in 2008. Results: Among
165 patients, 27 patients (16.4%; 6 male, 21 female) with mean (6 SD)
age of 72.6 (6 6.36) years suffered dementia. The number of Alzheimer’s
disease (AD) patients was 16 (59.3%; 3 male, 13 female). Nineteen patients
including 11 AD patients among the demented patients were hospitalized for
treatment of behavioral and psychological symptoms of dementia (BPSD),
and seven patients including four AD patients among them were hospitalized
due to somatic disease. The other one AD patient was hospitalized for dis-
crimination of dementia. Mean waiting period for admission of whole de-
mented patients was 16.8 days, but the mean waiting period of 12 patients
with low ADL levels was 25.4 days. Conclusions: According to the present
condition of this psychiatric ward, the roles of a psychiatric ward of a general
hospital in medical services for patients who suffered dementia are consid-
ered to be treatment of BPSD and somatic disease accompanied by BPSD,
and a close inspection for dementia. More clinical effort is required of us
to completely fill the roles, especially treatment of somatic disease accompa-
nied by BPSD, but drastic reforms for an evaluation system of fees for gen-
eral hospital psychiatry are also required.
P2-071 ‘‘DEMENTIA-FRIENDLY HOSPITALS: CARE NOT
CRISIS’’dIMPROVING THE CARE OF THE
HOSPITALIZED PATIENT WITH DEMENTIA
James E. Galvin1, Barbara Kuntemeier1, Noor Al-Hammadi1,
Jessica Germino1, Maggie Murphy-White2, Janis McGillick2, 1Washington
University, St Louis, MO, USA; 2St Louis Chapter, Alzheimer’s Association,St Louis, MO, USA. Contact e-mail: [email protected]
Background: Approximately 3.2 million hospital stays annually involve
a person with dementia, leading to higher costs, longer lengths of stay and
poorer outcomes. Older adults with dementia are vulnerable when hospitals
are unable to meet their special needs. Methods: We developed, imple-
mented and evaluated a training program for 540 individuals at 4 community
hospitals. Pre-test, post-test and a 120-day delayed post-test were collected to
assess knowledge, confidence and practice parameters. Results: The mean
age of the sample was 46y; 83% were Caucasian, 90% were female
and 60% were nurses. Upon completion, there were significant gains (p’s
< .001) in knowledge and confidence in recognizing, assessing and manag-
ing dementia care. Attendees reported gains in communication skills and
strategies to improve the hospital environment, patient safety and behavioral
management. At 120 days, 3 of 4 hospitals demonstrated maintenance of
confidence. In the hospital that demonstrated lower knowledge and confi-
dence scores, the sample was older and had more nurses and more years in
practice. Conclusions: We demonstrate the feasibility of training hospital
staff about dementia and its impact on patient outcomes. At baseline, there
was low knowledge and confidence in the ability to care for dementia pa-
tients. Training had an immediate impact on knowledge, confidence and at-
titudes with lasting impact in 3 of 4 hospitals. We identified targets for