Behavioral and psychological symptoms in community-dwelling elders with cognitive impairment: Effects on use of psychotropic medications, supportive services, and nursing home placement.

摘要

Little is known about the prevalence and correlates of behavioral and psychological symptoms of dementia (BPSD) and the impact of these symptoms on health services use in representative samples of community-dwelling elders with cognitive impairment.; This study used baseline and first annual follow-up data from the observational, longitudinal Memory and Medical Care Study (MMCS) conducted at the Johns Hopkins Medical Institutions. The sample was 482 elders classified as having dementia or mild cognitive impairment (MCI) on the basis of neuropsychiatric testing. Information was collected from a proxy knowledgeable informant (KI) for each subject.; First, I determined the prevalence and correlates of BPSD. 66% of dementia subjects and 47% of MCI subjects had at least one BPSD at baseline. BPSD was associated with having a physician's diagnosis of dementia. Correlates of BPSD differed by dementia or MCI classification, and types of BPSD (psychosis, depression, agitation).; Second, I determined the effect of BPSD on medical and supportive services use. There was no association between types of BPSD and different categories of psychotropics use (cognitive enhancers, antidepressants, neuroleptics, anxiolytics/hypnotics, and anti-agitation drugs). However, subjects having a physician's diagnosis of dementia were associated with both higher rates of BPSD and psychotropics use. There was also no association between BPSD and supportive service use (in-home paid services, and community services).; Finally, I found that BPSD, psychotropics use, and supportive services use were not independent risk factors for time to nursing home placement. Instead, poor physical health rating, and more severe cognitive and functional impairments, were associated with shorter time to nursing home entry.; I confirmed that BPSD were common in community-dwelling elders with dementia or MCI. These findings suggested that these symptoms might prompt family caregivers to initiate clinical assessment for dementia diagnosis and subsequent prescription of psychotropics. However, there was no evidence that presence of BPSD hastens nursing home placement and that use of psychotropics or supportive services delays nursing home placement. Because the use of psychotropics is not effective in managing BPSD to delay nursing home placement, other treatment modalities such as behavioral interventions and environmental adjustment should be added.