Impact of Systematic Tracking of Dementia Cases on the Rate of Hospitalization in Emergency Care Units (IDEM)

July 28, 2020 updated by: University Hospital, Toulouse

Interest of Systematic Tracking of Dementia Cases in Nursing Homes: Analysing the Contribution of MultiDisciplinary Team Meeting (MDTM) in Alzheimer's Disease and Related Diseases

Introduction: Epidemiological data show that in France only half of patients with Alzheimer disease are currently diagnosed in the general population. The absence of early diagnosis of dementia reduces the opportunities of patients to receive optimal care. One of the consequences of undiagnosed dementia is inadequate use of emergency care units.

The main objective: The main aim of this study is to evaluate the impact of a systematic case-finding procedure of dementia cases in nursing homes through a MDTM on the rate of hospitalization in emergency care units.

Secondary objectives:

To assess the impact of systematic tracking of dementia cases on the:

  • Quantity and quality of drug-prescription
  • Appropriateness of hospitalizations
  • Prevalence of neuropsychiatric symptoms
  • Dependency
  • Quality of life
  • Burden of nursing staff working conditions
  • Planning of specific therapeutic measures
  • Overall health care costs

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

This is a multicentre, cluster randomized study comparing two parallel groups:

  • Intervention group: nursing homes whose residents benefit from MDTM to identify the cases of dementia and to propose an adequate care project
  • Control group: nursing homes whose residents continue to benefit from usual care In each group, 1000 elderly subjects aged over 60 years without documented diagnosis of dementia will be included and monitored for a period of 18 months.

Information about the main and secondary aims will be collected monthly through online questionnaires.

Study Type

Interventional

Enrollment (Actual)

1428

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • France
      • Agen, France
        • Centre de Gerontologie Pompeyrie Chu Agen
      • Albi, France
        • Ehpad Maison de Retraite Louise Anceau
      • Albi, France
        • Ehpad Maison de Retraite Olga Ducoudray
      • Albi, France
        • Ehpad Mr "Les Jardins de Jouvence"
      • Albi, France
        • Mapad La Renaudie Ch Albi
      • Allaire, France
        • Ehpad Les Ajoncs D'Or
      • Ax-les-Thermes, France
        • Ehpad Maison de Retraite Hl Ax Les Thermes
      • Balma, France
        • Ehpad Marie Lehman
      • Brest, France
        • Ehpad Kerdigemer
      • Brest, France
        • Ehpad Residence Ker-Heol
      • Catus, France
        • Ehpad Residence Saint Astier
      • Caussade, France
        • Mapa de L'Hopital Local de Caussade
      • Ceignac, France
        • Ehpad Maison de Retraite Ste Marthe
      • Cepet, France
        • EHPAD Résidence Castelgirou
      • Clermont L'herault, France
        • Ehpad Leon Ronzier Joly
      • Colomiers, France
        • Ehpad Themis Lasplanes
      • ERR, France
        • Ehpad Maison de Retraite Joseph Sauvy
      • Escalquens, France
        • Ehpad Residence Borde Haute Promo-Accueil
      • Firmi, France
        • Mapad "Firmi"
      • Fleurance, France
        • Ehpad Hopital Local Fleurance
      • Foix, France
        • Ehpad Mr Bellissen Chi Du Val D'Ariege
      • Guer, France
        • Ehpad Dr Robert
      • L'union, France
        • Ehpad Residence Grand'Maison
      • La Roquebrussanne, France
        • Ehpad Residence Provencale Medicafrance
      • Lamorlaye, France
        • Ehpad Residence Clairefontaine
      • Lavaur, France
        • Mapad Ch Lavaur
      • Le Conquet, France
        • Ehpad Saint Reah Hir
      • Le Mee Sur Seine, France
        • Ehpad Residence D'Automne de La Ferme
      • Lescure d'Albigeois, France
        • Ehpad Maison de Retraite "Les Charmilles"
      • Lezat Sur Leze, France
        • Residence Le Parc
      • Lherm, France
        • Ehpad La Cheneraie
      • Lisle Sur Tarn, France
        • Ehpad Mr Lagrange
      • Lourdes, France
        • Mapad Labastide Ch Lourdes
      • Marchiennes, France
        • Ehpad Emile Dubois
      • Marciac, France
        • Ehpad Les Mille Soleils
      • Marines, France
        • Ehpad Et. Public Gerontologie de Marines
      • Marseille, France, 13385
        • AP-HM Hôptal La Timone Service de Pédiatrie Mutidisciplinaire
      • Mauvezin, France
        • Ehpad Maison Retraite Hl Mauvezin
      • Mazamet, France
        • Ehpad Maison de Retraite Saint Joseph
      • Mazeres, France
        • Ehpad Maison de Retraite Privee de Mazeres
      • Mirande, France
        • Ehpad-Maison Retraite Hl Mirande
      • Moissac, France
        • Ehpad Chis Castelsarrasin-Moissac
      • Montauban, France
        • Ehpad Maison Retraite Ch Montauban
      • Montauban de Luchon, France
        • Ehpad Era Caso
      • Montpellier, France
        • Ehpad Ma Maison
      • Montredon Labessonnie, France
        • Ehpad Maison de Retraite Sainte Agnes
      • Mèze, France
        • Ehpad L'Ecrin Des Sages
      • Nailloux, France
        • Ehpad L'Acacia
      • Naucelle, France
        • Logements Foyer La Fontanelle
      • Nice, France
        • Ehpad Fondation Pauliani
      • Nice, France
        • Ehpad Les Noisetiers
      • Nice, France
        • Ehpad Residence Ancilla
      • Ossun, France
        • Ehpad Mais de Retraite Saint-Joseph
      • Pamiers, France
        • Ehpad Mr Bariol Chi Du Val D'Ariege
      • Panazol, France
        • Ehpad Residence Le Parc
      • Paris, France, 75015
        • AP-HP Hôpital Necker Enfants Malades Service d'endocrinologie pédiatrique - 149 route de Sèvres
      • Paris, France
        • Ehpad Furtado Heine
      • Paris, France
        • Ehpad Julie Siegfried
      • Paris, France
        • Ehpad La Pirandelle
      • Paris, France
        • Ehpad Residence Anselme
      • Paris, France
        • Ehpad Residence Belleville
      • Paris, France
        • Ehpad Residence Herold
      • Paris, France
        • Ehpad Residence Oceane
      • Paris, France
        • Ehpad Tiers Temps Paris
      • Pierre Buffiere, France
        • Ehpad Residence Adeline
      • Reims, France
        • Ehpad Residence D'Automne Medica-France
      • Rieux Volvestre, France
        • Ehpad L'Oree Du Bois
      • Rodez, France
        • Ehpad Residence Saint-Amans
      • Saint Bonnet, France
        • Ehpad Le Jardin Des Loges
      • Saint Lys, France
        • Ehpad Residence Themis La Joie de Vivre
      • Saint Orens de Gameville, France
        • Ehpad A Labouilhe
      • Saint Remy de Provence, France
        • Ehpad Public de Saint-Remy de Provence
      • Sousceyrac, France
        • Ehpad Les Bruyeres
      • St Gaudens, France
        • Ehpad Maison Retraite Orelia Ch St Gaudens
      • St Martory, France
        • Ehpad Genevriers
      • Tarbes, France
        • Ehpad Maison de Retraite Chic Tarbes Vic
      • Tarbes, France
        • Ehpad Residence "Le Doyenne Du Carmel"
      • Tinteniac, France
        • Ehpad Sainte Anne
      • Toulouse, France
        • Ehpad de La Cote Pavee
      • Toulouse, France
        • Ehpad Gaubert
      • Toulouse, France
        • Ehpad Mr Henri Iv
      • Toulouse, France
        • Ehpad Pierre Ducis
      • Toulouse, France
        • Ehpad Residence La Cotonniere
      • Toulouse, France
        • Ehpad Residence Le Clos Des Carmes
      • Toulouse, France
        • Ehpad Residence Marguerite
      • Toulouse, France
        • Ehpad Residence Saint-Simon
      • Toulouse, France
        • Usld Domaine de La Cadene
      • Valence-d'albigeois, France
        • Ehpad Umt
      • Villefranche de Lauragais, France
        • Ehpad Maisonneuve
      • Villemur Sur Tarn, France
        • Ehpad Saint-Jacques

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

60 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Residents of both sex, aged 60 years or over
  • Residents living in a nursing home participating in the study
  • Residents living in the nursing home for 30 days or more

  • Residents without diagnosed and documented dementia, identified as follows:

    • residents not identified by the French Healthcare system as suffering from dementia (ALD 15)
    • residents not benefiting from a specific care program or a specialized follow-up for dementia
    • residents for whom there is no appropriate investigation for dementia diagnosis in medical records
    • residents not taking specific drugs for dementia (Cholinesterase inhibitors and/or Memantine)
  • Residents and their GP having received information about the study
  • Residents and their GP having expressed their agreement to participate in the study

Exclusion Criteria:

  • Residents aged less than 60 years
  • Residents not living in a nursing home participating in study
  • Residents living in nursing home for less than 30 days

  • Residents with diagnosed and documented dementia, identified as follows:

    • residents Identified by the French Healthcare system as suffering from dementia (ALD 15)
    • residents benefiting from specific care programme or specialized follow-up for dementia
    • residents for whom there is appropriate investigation for dementia diagnosis in medical records
    • residents taking specific drugs for dementia (Cholinesterase inhibitors and/or Memantine)
  • Residents and/or their GP who received no information about the study
  • Residents and/or their GP having expressed their opposition to participate in the study

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Other: Intervention group
Intervention group: nursing homes whose residents benefit from MDTM to identify the cases of dementia and to propose an adequate care project
Other: MultiDisciplinary Team Meetings (MDTM)
The MDTM, between the memory experts and Nursing Home coordinating practitioners, could help the nursing home medical staff identify the cases of dementia and propose these residents an adequate healthcare project (supplementary investigations, therapeutic modifications, hospitalizations...)
No Intervention: control group
Control group: nursing homes whose residents continue to benefit from usual care

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Incidence of hospitalizations in emergency care units
Time Frame: 18 months
Monthly collection during follow-up (18 months)
18 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Prevalence of antipsychotic prescription
Time Frame: Baseline visit, 4 months, 18 months
Baseline visit, 4 months, 18 months
Incidence of inappropriate hospitalizations
Time Frame: 18 months
Monthly collection during follow-up (18 months)
18 months
Prevalence of neuropsychiatric symptoms evaluated by NPI-nursing staff version
Time Frame: Baseline visit, 18 months
Baseline visit, 18 months
Dependency evaluated by AGGIR and IADL-4 items
Time Frame: Baseline visit, 18 months
Baseline visit, 18 months
Quality of life evaluated by QOL-AD
Time Frame: Baseline visit, 18 months
Baseline visit, 18 months
Number of nursing staff's time off work
Time Frame: 18 months
Monthly collection during follow-up (18 months)
18 months
Number of days off work by nursing staff
Time Frame: 18 months
Monthly collection during follow-up (18 months)
18 months
Presence of advanced care planning in patients medical records
Time Frame: Baseline visit, 18 months
Advanced care planning will be checked through behavioural disosders, transfer to hospital intensive care and resuscitation
Baseline visit, 18 months
Overall healthcare costs
Time Frame: 18 months
Monthly collection during follow-up (18 months)
18 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University Hospital, Toulouse

Investigators

  • Principal Investigator: Pierre ALLAN, MD, EHPAD MAISON DE RETRAITE SAINT JOSEPH - MAZAMET
  • Principal Investigator: Véronique ARNAUD-ULLIET, MD, EHPAD MA MAISON MONTPELLIER

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

May 1, 2010

Primary Completion (Actual)

September 1, 2013

Study Completion (Actual)

September 1, 2013

Study Registration Dates

First Submitted

July 4, 2011

First Submitted That Met QC Criteria

March 30, 2012

First Posted (Estimate)

April 4, 2012

Study Record Updates

Last Update Posted (Actual)

July 29, 2020

Last Update Submitted That Met QC Criteria

July 28, 2020

Last Verified

July 1, 2020

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 0910701
  • 2009-A01062-55 (Other Identifier: ID-RCB)

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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