The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: a longitudinal cohort study.
The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: a longitudinal cohort study.
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DOI：
10.1002/gps.4463
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发表时间：
2017-03
影响因子：
4
通讯作者：
Sampson EL
中科院分区：
文献类型：
--
作者：
White N;Leurent B;Lord K;Scott S;Jones L;Sampson EL
急性病医院对痴呆症患者来说是一个具有挑战性的地方。痴呆症（BPSD）的行为和心理症状很常见，并可能因医院环境而加剧。人们对BPSD在这种情况下如何管理以及过度依赖神经安定药物表示担忧。本研究旨在调查英国急症医院如何管理BPSD。一个纵向队列的230例痴呆症患者承认两个急性NHS医院。每四天测量一次BPSD（行为-AD量表），以及记录药物处方和非药物管理。BPSD的总体患病率为75%，其中攻击和活动障碍最常见。28例（12%）患者处方了抗精神病药物;其中70%的处方是入院时新开的。27例（12%）患者处方了苯二氮卓类药物，37例（16%）患者处方了抗抑郁药，14例（3%）患者处方了镇静剂。在调整了临终药物、年龄和痴呆严重程度后，服用抗精神病药物的患者死亡的可能性显著更高（调整后的风险比5.78，95% CI 1.57，21.26，p = 0.008）。55%的参与者使用非药物管理，最常见的是心理社会干预（36%），几乎没有证据表明监测其有效性。在50例（22%）患者入院期间使用了某种形式的约束。抗精神病药物和心理社会干预是用于管理BPSD的主要方法;然而，这些方法没有以系统的方式实施或监测。
The acute hospital is a challenging place for a person with dementia. Behavioural and psychological symptoms of dementia (BPSD) are common and may be exacerbated by the hospital environment. Concerns have been raised about how BPSD are managed in this setting and about over reliance on neuroleptic medication. This study aimed to investigate how BPSD are managed in UK acute hospitals. A longitudinal cohort of 230 patients with dementia admitted to two acute NHS hospitals. BPSD were measured every four days (Behave‐AD scale), as well as documentation of pharmacological prescriptions and non‐pharmacological management. The overall prevalence of BPSD was 75%, with aggression and activity disturbance being the most common. Antipsychotics were prescribed for 28 (12%) patients; 70% of these prescriptions were new on admission. Benzodiazepines were prescribed for 27 (12%) patients, antidepressants were prescribed for 37 (16%) patients, and sedatives were prescribed for 14 (3%) patients. Patients who were prescribed antipsychotics, after adjusting for end of life medication, age and dementia severity, were significantly more likely to die (adjusted hazard ratio 5.78, 95% CI 1.57, 21.26, p = 0.008). Non‐pharmacological management was used in 55% of participants, most commonly psychosocial interventions (36%) with little evidence of monitoring their effectiveness. A form of restraint was used during 50 (22%) patients' admissions. Antipsychotic medications and psychosocial interventions were the main methods used to manage BPSD; however, these were not implemented or monitored in a systematic fashion.