Management of Agitation in Dementia and Effects on Inpatient Length of Stay

  • Isabelle Silverstone-Simard GeriPARTy Research Group, Lady Davis Institute/Jewish General Hospital, McGill University
  • Joyce Wu GeriPARTy Research Group, Lady Davis Institute/Jewish General Hospital, McGill University
  • Marouane Nassim GeriPARTy Research Group, Lady Davis Institute/Jewish General Hospital, McGill University
  • Ruby Friedman Lady Davis Institute/Jewish General Hospital, McGill University
  • Marilyn Segal Lady Davis Institute/Jewish General Hospital, McGill University
  • Johanne Moette Lady Davis Institute/Jewish General Hospital, McGill University
  • Soham Rej GeriPARTy Research Group, Lady Davis Institute/Jewish General Hospital, McGill University, Montreal
Keywords: agitation, dementia, geriatric inpatient unit, length of stay, time until dischargeable

Abstract

Background

Agitation associated with dementia impacts delivery of medical care and is a major reason for institutionalization in dementia patients. This study examines the association of medication use and other clinical factors with patients’ ‘dischargeability’ (i.e., amount of time until a patient is considered dischargeable from an inpatient unit).

Methods

This study was a retrospective chart review examining 200 patients with dementia and agitation, hospitalized at a Canadian acute care geriatric ward between November 2007 and November 2018. The main outcome measure was time until a patient was deemed dischargeable. Univariate linear regression analyses, followed by multiple linear regression analyses, were used.

Results

Risperidone and quetiapine were the most commonly prescribed medications, but were not associated with time until dischargeable. Olanzapine (40.9 vs. 16.2 days until dischargeable, β = 0.23, p = .001), regular benzodiazepine (32.7 vs. 16.5 days until dischargeable, β = 0.15, p = .027), and as-needed (‘PRN’) benzodiazepine use (31.7 vs. 15.9 days until dischargeable, β =0.19, p = .006) were independently associated with prolonging time until dischargeable.

Conclusions

Olanzapine, benzodiazepine, and PRN benzodiazepine use were associated with longer time until patients with dementia and agitation were considered ready for discharge. This raises the question as to whether the risks of these medications outweigh the benefits in a hospital setting.

 

Author Biographies

Isabelle Silverstone-Simard, GeriPARTy Research Group, Lady Davis Institute/Jewish General Hospital, McGill University

Department. of Psychiatry, Lady Davis Institute/Jewish General Hospital, McGill University

Joyce Wu, GeriPARTy Research Group, Lady Davis Institute/Jewish General Hospital, McGill University

Department of Psychiatry

Marouane Nassim, GeriPARTy Research Group, Lady Davis Institute/Jewish General Hospital, McGill University

Department of Psychiatry

Ruby Friedman, Lady Davis Institute/Jewish General Hospital, McGill University

Division of Geriatric Medicine

Marilyn Segal, Lady Davis Institute/Jewish General Hospital, McGill University

Division of Geriatric Medicine

Johanne Moette, Lady Davis Institute/Jewish General Hospital, McGill University

Division of Geriatric Medicine

Published
2021-05-11
How to Cite
Silverstone-Simard, I., Wu, J., Nassim, M., Friedman, R., Segal, M., Moette, J., & Rej, S. (2021). Management of Agitation in Dementia and Effects on Inpatient Length of Stay. Canadian Geriatrics Journal, 24(2), 111-117. https://doi.org/10.5770/cgj.24.483
Section
Original Research