Hospital practices and clinical outcomes associated with behavioral symptoms in persons with dementia

Rachel Tannenbaum, Marie Boltz, Anum Ilyas, Valeria Gromova, Suzanne Ardito, Mutahira Bhatti, Gwenyth Mercep, Michael Qiu, Gisele Wolf-Klein, Zaldy S. Tan, Jason Wang, Liron Sinvani

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background: Hospitalized persons living with dementia (PLWD) often experience behavioral symptoms that challenge medical care. Objective: This study aimed to identify clinical practices and outcomes associated with behavioral symptoms in hospitalized PLWD. Design: A retrospective cross-sectional study. Settings and Participants: The study included PLWD (65+) admitted to one of severe health system hospitals in 2019. Intervention: Behavioral symptoms were defined as the presence of (1) a psychoactive medication for behavioral symptoms; (2) an order for physical restraints or constant observation; and/or (3) physician documentation of delirium, encephalopathy, or behavioral symptoms. Main Outcome and Measures: Associations between behavioral symptoms and patient characteristics and hospital practices (e.g., bladder catheter) were examined. Multivariable logistic/linear regression was used to evaluate the association between behavioral symptoms and clinical outcomes (e.g., mortality). Results: Of hospitalized PLWD (N = 8637), the average age was 84.5 years (IQR = 79−90), 61.7% were female, 60.1% were white, and 9.4% (n = 833) were Hispanic. Behavioral symptoms were identified in 40.6% (N = 3606) of individuals. Behavioral symptoms were significantly associated with male gender (40.3% vs. 36.9%, p =.001), white race (62.7% vs. 58.3%, p <.001), and residence in a facility prior to admission (26.6% vs. 23.7%, p <.001). Regarding hospital practices, indwelling bladder catheters (11.2% vs. 6.0%, p <.001) and dietary restriction (41.9% vs. 33.8%, p <.001) were associated with behavioral symptoms. In multivariable models, behavioral symptoms were associated with increased hospital mortality (odds ratio [OR]: 1.90, CI95%: 1.57−2.29), length of stay (parameter estimate: 2.10, p <.001), 30-day readmissions (OR: 1.14, CI95%: 1.014–1.289), and decreased discharge home (OR: 0.59, CI95%: 0.53−0.65, p <.001). Conclusions: Given the association between behavioral symptoms and poor clinical outcomes, there is an urgent need to improve the provision of care for hospitalized PLWD.

Original languageEnglish (US)
JournalJournal of Hospital Medicine
StatePublished - Sep 2022

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Leadership and Management
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis


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