@article {9321, title = {Distress Associated with Dementia-Related Psychosis and Agitation in Relation to Healthcare Utilization and Costs.}, journal = {American Journal of Geriatric Psychiatry}, volume = {25}, year = {2017}, month = {2017 Oct}, pages = {1074-1082}, abstract = {

OBJECTIVES: Explore the relationship between behavioral and psychological symptoms of dementia (BPSD; specifically, delusions, hallucinations, and agitation/aggression) and associated caregiver distress with emergency department (ED) utilization, inpatient hospitalization, and expenditures for direct medical care.

DESIGN/SETTING/PARTICIPANTS: Retrospective cross-sectional cohort of participants with dementia (N = 332) and informants from the Aging, Demographics, and Memory Study, a nationally representative survey of U.S. adults >70 years old.

MEASUREMENTS: BPSD of interest and associated informant distress (trichotomized as none/low/high) were assessed using the Neuropsychiatric Inventory (NPI). Outcomes were determined from one year of Medicare claims and examined according to presence of BPSD and associated informant distress, adjusting for participant demographics, dementia severity, and comorbidity.

RESULTS: Fifty-eight (15\%) participants with dementia had clinically significant delusions, hallucinations, or agitation/aggression. ED visits, inpatient admissions, and costs were not significantly higher among the group with significant BPSD. In fully adjusted models, a high level of informant distress was associated with all outcomes: ED visit incident rate ratio (IRR) 3.03 (95\% CI: 1.98-4.63; p < 0.001), hospitalization IRR 2.78 (95\% CI: 1.73-4.46; p < 0.001), and relative cost ratio 2.00 (95\% CI: 1.12-3.59; p = 0.02).

CONCLUSIONS: A high level of informant distress related to participant BPSD, rather than the symptoms themselves, was associated with increased healthcare utilization and costs. Effectively identifying, educating, and supporting distressed caregivers may help reduce excess healthcare utilization for the growing number of older adults with dementia.

}, keywords = {Dementia, Depressive symptoms, Healthcare, Stress}, issn = {1545-7214}, doi = {10.1016/j.jagp.2017.02.025}, author = {Donovan T Maust and Helen C Kales and Ryan J McCammon and Frederic C. Blow and Amanda N Leggett and Kenneth M. Langa} } @article {8918, title = {Psychotropic use and associated neuropsychiatric symptoms among patients with dementia in the USA.}, journal = {International Journal of Geriatric Psychiatry}, volume = {32}, year = {2017}, month = {2017 Feb}, pages = {164-174}, abstract = {

OBJECTIVE: To determine the national prevalence of psychotropic use and association with neuropsychiatric symptoms among patients with dementia.

METHODS: Participants diagnosed with dementia (n = 414) in the Aging, Demographics, and Memory Study, a nationally representative survey of US adults >70 years old. Diagnosis was based on in-person clinical assessment and informant interview. Information collected included demographics, place of residence, 10-item Neuropsychiatric Inventory (NPI), and prescribed medications (antipsychotic, sedative-hypnotic, antidepressant, mood stabilizer).

RESULTS: Of 414 participants with dementia, 41.4\% were prescribed a psychotropic medication, including 84.0\% of nursing home residents and 28.6\% of community-dwellers. Of participants, 23.5\% were prescribed an antidepressant. Compared with the total NPI score of those on no medication (4.5), those on antipsychotics and those on sedative-hypnotics had much higher scores (respectively: 12.6, p < 0.001; 11.8, p = 0.03), although those antidepressants did not (6.9, p = 0.15). A larger proportion of patients on antipsychotics exhibited psychosis and agitation compared with those on no medication, while those on antidepressants exhibited more depressive symptoms. In multivariable logistic regression that included dementia severity and nursing home residence, nursing home residence was the characteristic most strongly associated with psychotropic use (odds ratio ranging from 8.96 [p < 0.001] for antipsychotics to 15.59 [p < 0.001] for sedative-hypnotics). More intense psychotic symptoms and agitation were associated with antipsychotic use; more intense anxiety and agitation were associated with sedative-hypnotic use. More intense depression and apathy were not associated with antidepressant use.

CONCLUSIONS: In this nationally representative sample, 41.4\% of patients were taking psychotropic medication. While associated with neuropsychiatric symptoms, nursing home residence was most strongly tied to use. Copyright {\textcopyright} 2016 John Wiley \& Sons, Ltd.

}, keywords = {ADAMS, Antidepressants, Dementia, Drug use, Older Adults, Psychiatry}, issn = {1099-1166}, doi = {10.1002/gps.4452}, author = {Donovan T Maust and Kenneth M. Langa and Frederic C. Blow and Helen C Kales} }