Dementia in Nursing Home
Conditions
Keywords
Dementia, emergency hospitalization, nursing home, multidisciplinary meeting, cognitive decline, disability, residents, facilities, long term care unit, health policy, general practitioner, prevention
Brief summary
Introduction: Epidemiological data show that in France only half of patients with Alzheimer disease are currently diagnosed in the general population. The absence of early diagnosis of dementia reduces the opportunities of patients to receive optimal care. One of the consequences of undiagnosed dementia is inadequate use of emergency care units. The main objective: The main aim of this study is to evaluate the impact of a systematic case-finding procedure of dementia cases in nursing homes through a MDTM on the rate of hospitalization in emergency care units. Secondary objectives: To assess the impact of systematic tracking of dementia cases on the: * Quantity and quality of drug-prescription * Appropriateness of hospitalizations * Prevalence of neuropsychiatric symptoms * Dependency * Quality of life * Burden of nursing staff working conditions * Planning of specific therapeutic measures * Overall health care costs
Detailed description
This is a multicentre, cluster randomized study comparing two parallel groups: * Intervention group: nursing homes whose residents benefit from MDTM to identify the cases of dementia and to propose an adequate care project * Control group: nursing homes whose residents continue to benefit from usual care In each group, 1000 elderly subjects aged over 60 years without documented diagnosis of dementia will be included and monitored for a period of 18 months. Information about the main and secondary aims will be collected monthly through online questionnaires.
Interventions
OTHERMultiDisciplinary Team Meetings (MDTM)
The MDTM, between the memory experts and Nursing Home coordinating practitioners, could help the nursing home medical staff identify the cases of dementia and propose these residents an adequate healthcare project (supplementary investigations, therapeutic modifications, hospitalizations...)
Sponsors
University Hospital, Toulouse
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Residents of both sex, aged 60 years or over * Residents living in a nursing home participating in the study * Residents living in the nursing home for 30 days or more * Residents without diagnosed and documented dementia, identified as follows: * residents not identified by the French Healthcare system as suffering from dementia (ALD 15) * residents not benefiting from a specific care program or a specialized follow-up for dementia * residents for whom there is no appropriate investigation for dementia diagnosis in medical records * residents not taking specific drugs for dementia (Cholinesterase inhibitors and/or Memantine) * Residents and their GP having received information about the study * Residents and their GP having expressed their agreement to participate in the study
Exclusion criteria
* Residents aged less than 60 years * Residents not living in a nursing home participating in study * Residents living in nursing home for less than 30 days * Residents with diagnosed and documented dementia, identified as follows: * residents Identified by the French Healthcare system as suffering from dementia (ALD 15) * residents benefiting from specific care programme or specialized follow-up for dementia * residents for whom there is appropriate investigation for dementia diagnosis in medical records * residents taking specific drugs for dementia (Cholinesterase inhibitors and/or Memantine) * Residents and/or their GP who received no information about the study * Residents and/or their GP having expressed their opposition to participate in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of hospitalizations in emergency care units | 18 months | Monthly collection during follow-up (18 months) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of nursing staff's time off work | 18 months | Monthly collection during follow-up (18 months) |
| Prevalence of antipsychotic prescription | Baseline visit, 4 months, 18 months | — |
| Incidence of inappropriate hospitalizations | 18 months | Monthly collection during follow-up (18 months) |
| Prevalence of neuropsychiatric symptoms evaluated by NPI-nursing staff version | Baseline visit, 18 months | — |
| Number of days off work by nursing staff | 18 months | Monthly collection during follow-up (18 months) |
| Quality of life evaluated by QOL-AD | Baseline visit, 18 months | — |
| Presence of advanced care planning in patients medical records | Baseline visit, 18 months | Advanced care planning will be checked through behavioural disosders, transfer to hospital intensive care and resuscitation |
| Overall healthcare costs | 18 months | Monthly collection during follow-up (18 months) |
| Dependency evaluated by AGGIR and IADL-4 items | Baseline visit, 18 months | — |
Countries
France
Outcome results
None listed