Krolak-Salmon P, Roubaud C, Finne-Soveri H, Riolacci-Dhoyen N, Richard G, Rouch I, Leperre-Desplanques A, Dauphinot V
Clinical and Research Memory Centre of Lyon (CMRR), Charpennes Hospital, University Hospital of Lyon, Villeurbanne, France.
Clinical Research Centre (CRC) - VCF (Aging - Brain - Frailty), Charpennes Hospital, University Hospital of Lyon, Villeurbanne, France.
Eur J Neurol. 2016 May;23(5):979-88. doi: 10.1111/ene.12975. Epub 2016 Mar 6.
Preventing behavioural crises appears to be crucial to promote quality of life of the patient-caregiver dyad, to reduce inappropriate hospitalizations and to delay institutionalization. The Alzheimer Cooperative Valuation in Europe promotes mobile care to prevent patients from severe behavioural and psychological symptoms in dementia. This study assessed the potential efficacy of a mobile team for Alzheimer's disease on hospitalization sparing and behavioural disorder reduction.
A cohort study was set up from 1 January 2012 to 31 December 2013 by the Clinical and Research Memory Centre of Lyon (France). It included patients with behavioural and psychological symptoms living at home or in a nursing home. An interview explored the alternative patient pathways used by general practitioners (GPs) if the mobile team had not existed (hospitalization sparing). The Neuropsychiatry Inventory score was assessed at inclusion and 30 days later. The sample included 424 consecutive patients with Alzheimer's disease or related disorders and behavioural disorders at any cognitive and functional stage of the disease, taken in charge by the mobile team.
Amongst the 424 patients (84.0 ± 7.2 years), 220 (51.9%) hospitalizations were considered by their GPs and 181 (82.3%) were avoided. The Neuropsychiatric Inventory score declined after mobile team intervention (45.8-29.9, P < 0.001). Sleep and appetite disorders, endangered situation and caregiver burnout were associated with higher risk of hospitalization at 30 days.
The mobile team for Alzheimer's disease allows a high proportion of hospitalizations related to behavioural disorders to be avoided and may help to reduce behavioural disorders.
预防行为危机对于提高患者-照护者二元组的生活质量、减少不适当的住院治疗以及延缓机构化似乎至关重要。欧洲阿尔茨海默病合作评估项目提倡移动护理，以预防痴呆患者出现严重的行为和心理症状。本研究评估了阿尔茨海默病移动团队在减少住院率和降低行为障碍方面的潜在疗效。
法国里昂临床与研究记忆中心于2012年1月1日至2013年12月31日开展了一项队列研究。研究对象包括在家中或养老院生活且有行为和心理症状的患者。通过访谈探讨了如果没有移动团队，全科医生（GPs）会采用的替代患者就医途径（减少住院率）。在纳入研究时和30天后评估神经精神科问卷评分。样本包括424例连续的阿尔茨海默病或相关疾病患者，他们在疾病的任何认知和功能阶段均有行为障碍，由移动团队负责照护。
在424例患者（84.0±7.2岁）中，其全科医生认为有220例（51.9%）需要住院治疗，其中181例（82.3%）得以避免。移动团队干预后，神经精神科问卷评分下降（45.8 - 29.9，P<0.001）。睡眠和食欲障碍、处于危险状况以及照护者倦怠与30天时较高的住院风险相关。
阿尔茨海默病移动团队能够避免很大一部分与行为障碍相关的住院治疗，并可能有助于减少行为障碍。
