WASHINGTON – Patients admitted to a freestanding psychiatric hospital with a primary diagnosis of dementia with behavioral disturbance were more likely than those without dementia to experience medical deterioration during their stay, according to a chart review study of 1,000 consecutively admitted adults.
Azotemia or anemia on admission predicted an increased risk for such decompensation among the 71 who had dementia with behavioral disturbance. "Patients with such baseline findings should receive enhanced medical evaluation, monitoring, and management to decrease preventable interruptions in care," Dr. Eugene Grudnikoff and his associates reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.
Compared with the 929 nondemented patients who were admitted to the 208-bed psychiatric hospital between August and December 2010, the 71 with dementia were significantly older (78 vs. 43 years) and less likely to be male (40% vs. 54%). They were also more likely to have been transferred from another hospital (13% vs. 5%), be taking first-generation antipsychotics (27% vs. 15%), have a longer length of stay (23 vs. 19 days), and be transferred to the emergency department (42% vs. 12%).
Emergency transfer to the adjacent 480-bed medical center was used as a proxy measure for significant medical deterioration, said Dr. Grudnikoff and his associates at Zucker Hillside Hospital, Glen Oaks, N.Y., part of the North Shore–Long Island Jewish Health System.
The psychiatric patients with dementia had a significantly greater number of somatic disorders than did those without dementia, 3.8 vs. 2.8 overall. Specifically, they were more likely to have arterial hypertension (63% vs. 26%), dyslipidemia (32% vs. 19%), coronary artery disease (18% vs. 4%), heart failure (7% vs. 1%), cerebral vascular disease (13% vs. 0.5%), and hypothyroidism (17% vs. 5%). However, those without dementia were more likely to be obese (34% vs. 7% with a body mass index above 30 kg/m2).
The dementia and nondementia groups differed significantly with regard to admission laboratory data. The dementia patients had higher venous blood levels of potassium, chloride, blood urea nitrogen, and creatinine and significantly lower levels of calcium, protein, hemoglobin, and platelets. They also had higher rates of azotemia (26.5% vs. 4%), anemia (40% vs. 16%), and hypoalbuminemia (17% vs. 3%).
During their hospital stays, 30 of the dementia patients (42%) and 114 of the nondemented patients (12%) had a significant medical deterioration that required emergency transfer. Among the 30 with dementia, reasons for transfer included fever in eight patients (27%); falls in another eight (27%); hypoxia in three (10%); hypotension, chest pain, and deep vein thrombosis in two patients each (7%); and stroke, delirium, vomiting, rectal bleeding, and edema in one patient each (3%).
Within the dementia group, the positive predictive values for emergency transfer were 61% for azotemia and 61.5% for anemia, but just 30% for hypoalbuminemia. After evaluation and treatment during a stay in the emergency department of up to 23 hours, patients with dementia were more likely to be admitted to a medical unit of the general hospital (17% vs. 6.5%), Dr. Grudnikoff and his associates reported.
Dr. Grudnikoff stated that he has nothing to disclose. Two of the six study coauthors declared financial relationships with several pharmaceutical companies.