Therapeutic Intervention Code in a Cognitive Geriatric Unit

Therapeutic Intervention Code in a Cognitive Geriatric Unit: Retrospective Analysis

The diagnostic and therapeutic progresses, associated with modifications in lifestyle and socio-cultural level of populations, have led to a remarkable increase in life expectancy. At the same time, the increasing medicalization of the individual has eroded the traditional boundaries between health and illness, normal and pathological state. This leads to the patient losing his sense of ownership of his own death. If most patients died at home before the Second World War, 75% of the population dies in hospital or institution at the present date.

Most hospitals and care institutions have developed codes, in multidisciplinary internal consultation, to address the interruption or lack of implementation of treatments that make no sense from a medical point of vue. This avoids therapeutic relentlessness.The code in place within the CHU Brugmann is:

• code A: no therapeutic restriction
• code B: not to be resuscitated
• code C: not to be intensively treated (no escalation in therapeutic treatments)
• code D: best palliative care (progressive de-escalation in therapeutic treatments).

These codes are established in consultation with the patient or his legal representative and are re-evaluated in a multidisciplinary way every week.

Planning a care path and therefore establishing a therapeutic code is particularly important for people with cognitive impairment and dementia because the progressive loss of cognitive abilities complicates the process of decision making.

A large part of the admissions are made via the emergency department. For these patients, no therapeutic plan has been established beforehand. However, the perception of the functional and cognitive status of the patient directly influences the intensity of care provided. Cognitive disorders are a risk factor for the exclusion of access to palliative care for the elderly patient.

The objectives of this study are:

• To establish a record of the therapeutic limitation codes in an acute cognitive geriatric unit
• To correlate the therapeutic limitation code with the comorbidities of the patients

Study Overview

• Status: Completed
• Conditions: Cognitive Impairment
• Intervention / Treatment: Other: Medical File consultation

• Study Type: Observational
• Enrollment (Actual): 310

Contacts and Locations

Study Locations

• Belgium
  • Brussels, Belgium
    • CHU Brugmann

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 61 years and older (Older Adult)
• Accepts Healthy Volunteers: N/A
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Eldelry patients with cognitive imparement admitted in the geriatric unit 83 within the CHU Brugmann between 01-01-2016 and 31-12-2016.

Description

Inclusion Criteria:

Elderly patients with cognitive impairment admitted in the geriatric unit 83 within the CHU Brugmann between 01-01-2016 and 31-12-2016.

Exclusion Criteria:

None

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Retrospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Cognitive impairment; Geriatric patients with a cognitive impairment	Other: Medical File consultation; Medical File consultation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Therapeutic code	Therapeutic code	From 01-01-2016 till 31-12-2016
Cumulative Illness Rating Scale for Geriatrics	This scoring system measures the chronic medical illness ("morbidity") burden while taking into consideration the severity of chronic diseases in 14 items representing individual body systems. The cumulative final score can theoretically vary from 0 to 56.	From 01-01-2016 till 31-12-2016

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Age	Age	From 01-01-2016 till 31-12-2016
Sex	Sex	From 01-01-2016 till 31-12-2016
Ethnicity	Ethnicity	From 01-01-2016 till 31-12-2016

Collaborators and Investigators

• Sponsor: Murielle Surquin
• Investigators: Principal Investigator: Carolina Natalia Grande Pérez, MD, CHU Brugmann

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2017
• Primary Completion (Actual): October 1, 2017
• Study Completion (Actual): October 1, 2017

Study Registration Dates

• First Submitted: January 17, 2018
• First Submitted That Met QC Criteria: January 17, 2018
• First Posted (Actual): January 23, 2018

Study Record Updates

• Last Update Posted (Actual): January 23, 2018
• Last Update Submitted That Met QC Criteria: January 17, 2018
• Last Verified: January 1, 2018

More Information

Terms related to this study

• Keywords: Therapeutic code; Geriatry
• Additional Relevant MeSH Terms: Mental Disorders; Neurocognitive Disorders; Cognition Disorders; Cognitive Dysfunction
• Other Study ID Numbers: CHUB- status code

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No