Managing Challenging Behaviors in Persons with Dementia: A Retrospective Chart Review and Descriptive Analysis of a Unique Hospice Palliative Care Unit Specializing in Dementia Care
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PublisherThe University of Arizona.
DescriptionA Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
AbstractPatients with behaviors arising from dementia are often rejected for hospice admission because hospices are not equipped to manage these acute symptoms. In addition, patients with dementia on home teams are discharged to geropsychiatric units due to behaviors. These symptoms are often most distressing for family members and the staff that care for them. Despite this, there are no FDA approved medications or interventions for the management of these behavioral symptoms. In 2013, Hospice of the Valley decided to change a standard inpatient unit into a unit devoted to managing persons with dementia to meet this need. A convenience sample of 102 charts of Generalized Inpatient (GIP) admissions of patients with dementia admitted over 5 years for behaviors of hitting, screaming, paranoia/delusions/hallucinations, insomnia, pain, or agitation were reviewed. Pharmacologic and non-pharmacologic interventions, length of stay, oral intake, ambulation, and time to death or discharge were recorded and analyzed. Behaviors leading to admission were agitation (62), pain (53), hitting (37), screaming (35), paranoia/hallucinations (34), and insomnia (20). Psychoactive medications used were antipsychotics (76%), benzodiazepines (36%), morphine (86%), trazodone (42%), and antidepressants (33%), with no clear patterns of use with different behaviors. Nonpharmacologic interventions were documented for 77% of admissions. 51% of patients died within 2 weeks of admission, with pain and screaming most lethal (66% of each). In conclusion, pharmacologic interventions showed no specific patterns, and non-pharmacologic interventions were not documented for 23% of patients despite 100% actual usage per staff. In addition, the availability of the unit enabled direct admission or retention of challenging hospice patients. To our knowledge this is the only hospice inpatient unit in the country focusing on persons with dementia. We believe this research will be beneficial to other hospices, and will contribute to knowledge regarding managing behaviors in patients with dementia at end of life.