demented patients treated in the psychiatric ward of a japanese general hospital

1
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. Sko ¨ldunger, Britt-Marie Sjo ¨ lund, 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 ¼ 0.15) . 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 OFA 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. Galvin 1 , Barbara Kuntemeier 1 , Noor Al-Hammadi 1 , Jessica Germino 1 , Maggie Murphy-White 2 , Janis McGillick 2 , 1 Washington University, St Louis, MO, USA; 2 St 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 Poster Presentations P2 S333

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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