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

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.