Banko Steven J, Harrison Cecelia, Rittereiser Jennifer, Jurkovitz Claudine, Ellison James M
Georgetown University.
Value Institute at ChristianaCare.
Del Med J. 2021 Mar-Apr;93(2):82-87.
Much of the suffering and expense associated with treatment of persons with dementia (Major Neurocognitive Disorder) arises from associated noncognitive behavioral and psychological symptoms of dementia (BPSD). Although a consensus on the prevalence of BPSD is lacking, evidence suggests that most people with dementia will manifest one or more of these symptoms during the disorder's progression. BPSD raise the cost of care by leading to more frequent emergency room visits, more and longer hospitalizations, and earlier admission to long-term care facilities (LTCF). Treatment of BPSD presents a stressful challenge in LTCFs. We sought to investigate the care burden of BPSD in Delaware's LTCFs and to gather data that can inform management approaches.
Using REDCap, we created an anonymous cross-sectional survey designed for completion by LTCF administrators. The Delaware Health Care Facilities Association (DHCFA) and Delaware's Division of Services for Aging and Adults with Physical Disabilities (DSAAPD) encouraged participation. A link to the survey was emailed to the administrators of 81 facilities in Delaware. The resulting data were evaluated using descriptive statistics.
Forty-four of the 81 facilities surveyed opened the survey link. Thirty-eight facilities answered at least some of the questions, and 19 surveys were fully completed. The reported average prevalence of BPSD among Delaware LTCF residents with dementia was 49.3% (SD 28.9). The five most frequently reported BPSD symptoms were anxiety, agitation, wandering, dysphoria/depression, and appetite/eating abnormalities. All facilities reported employing a spectrum of pharmacologic and non-pharmacologic management strategies. Twenty-two of 24 respondents (91.7%) reported that behavioral health consultation was available at their facilities and 18 of 20 respondents (90.0%) indicated that they provided training on how to manage residents with BPSD.
BPSD are a pervasive concern among Delaware's LTCFs. LTCFs may benefit from the development of training programs and dissemination of treatment guidelines incorporating evidence-based interventions and their implementation in managing BPSD to improve care, decrease stress on residents and caregivers, and reduce some avoidable health care costs.
与痴呆症患者（重度神经认知障碍）治疗相关的许多痛苦和费用都源于痴呆症相关的非认知行为和心理症状（BPSD）。尽管目前缺乏关于BPSD患病率的共识，但有证据表明，大多数痴呆症患者在疾病进展过程中会出现一种或多种此类症状。BPSD会导致更频繁的急诊就诊、更长时间的住院治疗以及更早入住长期护理机构（LTCF），从而增加护理成本。在长期护理机构中，BPSD的治疗是一项具有挑战性的压力任务。我们旨在调查特拉华州长期护理机构中BPSD的护理负担，并收集可用于指导管理方法的数据。
我们使用REDCap创建了一项匿名横断面调查，供长期护理机构管理人员填写。特拉华州医疗保健设施协会（DHCFA）和特拉华州老年人及身体残疾成年人服务部（DSAAPD）鼓励参与。调查链接通过电子邮件发送给特拉华州81家机构的管理人员。使用描述性统计方法对所得数据进行评估。
81家接受调查的机构中有44家打开了调查链接。38家机构至少回答了部分问题，19份调查问卷完整填写。据报告，特拉华州长期护理机构中患有痴呆症的居民BPSD平均患病率为49.3%（标准差28.9）。报告最频繁出现的五种BPSD症状为焦虑、激动、徘徊、烦躁/抑郁以及食欲/饮食异常。所有机构均报告采用了一系列药物和非药物管理策略。24名受访者中有22名（91.7%）报告其机构提供行为健康咨询，20名受访者中有18名（90.0%）表示他们提供了关于如何管理患有BPSD居民的培训。
BPSD是特拉华州长期护理机构普遍关注的问题。长期护理机构可能会受益于制定培训计划并传播包含循证干预措施的治疗指南，以及在管理BPSD时实施这些指南，以改善护理、减轻居民和护理人员的压力，并减少一些可避免的医疗保健成本。
