Impact of Hospital Admission on Patients With Dementia
23 juin 2015 mis à jour par: Josune Martin Corral, Hospital Galdakao-Usansolo
People with dementia have complex medical, social, and psychological needs and can be exacerbated by physical illness and the complex relationships between health care systems, patients and their families or caregivers.
They are a vulnerable and fragile population that differs significantly from the population without dementia.
Therefore, the investigators propose the following objectives: 1.
To describe the evolution of dementia patients admitted during the study period in two hospitals in the Basque Health Service-Osakidetza and complications associated with such admissions.
2. To compare with a control group (matched by type of pathology, age and sex and adjusting for other clinical variables (severity of dementia ...) the patient's condition before and after admission, in terms of quality of life, dependency, instrumental activities of daily living and severity of dementia.
3. To compare the length of stay, complications, mortality rate, the degree of dependency and quality of life of patients with dementia compared to those without dementia, matched by groups of pathologies, gender and age.
Aperçu de l'étude
Statut
Inconnue
Les conditions
Intervention / Traitement
Type d'étude
Observationnel
Inscription (Réel)
413
Critères de participation
Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.
Critère d'éligibilité
Âges éligibles pour étudier
- Enfant
- Adulte
- Adulte plus âgé
Accepte les volontaires sains
Non
Sexes éligibles pour l'étude
Tout
Méthode d'échantillonnage
Échantillon de probabilité
Population étudiée
For this prospective matched cohort study, the investigators recruited two groups of adults aged 75 years and older with an unplanned medical admission to any medical speciality between January 2012 and December 2014 in the Galdakao-Usansolo Hospital in the Basque Country (northern Spain), a 400-bed general teaching hospital serving a population of 300,000.
It is one of the networks of public hospitals of the Basque Health Service, which provides free unrestricted care to nearly 100% of the population.
One group (patients with dementia cohort) was drawn from patients with dementia, and a second group (patients without dementia cohort) of patients without dementia.
La description
Inclusion Criteria:
- For the patients with dementia cohort, the inclusion criteria were: (a) Being patient aged over 75 years; (b) having been diagnosed with dementia according to the Diagnostic and Statistical Manual for Mental Disorders-IV (American Psychiatric Association, 1994) by any of the psychiatrists; (c) having received inpatient treatment by the time of the study in the hospital//with an unplanned medical admission to any medical speciality in the Galdakao-Usansolo Hospital (d) agreeing to participate voluntarily and providing written informed consent. Patients with dementia were included if a caregiver agreed to participate voluntarily. Caregiver is defined as any person who cares for a needy person in his or her direct environment on a regular basis and more or less as a matter of course. The caregiver is related (family, friend…) to the person receiving care and is not a professional caregiver (Shoenmakers et al., 2010).
- For the cognitive intact patients cohort, the inclusion criteria were patients without dementia admitted in the hospital by the time of the study, matched with patients with dementia, after controlling for age, gender and types of pathologies.
Exclusion Criteria:
- Patients with dementia (or caregivers) were excluded if they did not provide inform consent.
- The exclusion criteria for patients without dementia were disorders interfering with psychometric assessment, or not given written informed consent.
Plan d'étude
Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.
Comment l'étude est-elle conçue ?
Détails de conception
Cohortes et interventions
Groupe / Cohorte |
Intervention / Traitement |
|---|---|
|
inpatients with dementia
|
Autre: mortality at discharge and 3-months after the admission in patients with and without dementia
Patients diagnosed of dementia who ingresed the hospital were informed of the goals of the study and invited to voluntarily participate.
In order to take part in the study, patients were required to provide informed consent.
All participants were first screened with the Alzheimer's Disease Test.
A diagnosis of dementia was generated by an independent clinician experienced in old age psychiatry using a structured clinical assessment based on operationalized DSM-IV criteria.
Clinical data were gathered from hospital notes.
Information on sociodemographic data, premorbid basic and instrumental activities of daily living, quality of life and burden of the caregiver was gathered from carers and review of hospital notes.
In both cohorts, participants were telephoned 3 months after hospital admission to respond the follow-up questionnaires.
Patients who decided not to answer them were considered lost to follow-up.
All information was kept confidential.
|
|
inpatients without dementia
|
Autre: mortality at discharge and 3-months after the admission in patients with and without dementia
Patients diagnosed of dementia who ingresed the hospital were informed of the goals of the study and invited to voluntarily participate.
In order to take part in the study, patients were required to provide informed consent.
All participants were first screened with the Alzheimer's Disease Test.
A diagnosis of dementia was generated by an independent clinician experienced in old age psychiatry using a structured clinical assessment based on operationalized DSM-IV criteria.
Clinical data were gathered from hospital notes.
Information on sociodemographic data, premorbid basic and instrumental activities of daily living, quality of life and burden of the caregiver was gathered from carers and review of hospital notes.
In both cohorts, participants were telephoned 3 months after hospital admission to respond the follow-up questionnaires.
Patients who decided not to answer them were considered lost to follow-up.
All information was kept confidential.
|
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Mortality during hospitalization and at follow-up
Délai: Up to 3 months
|
In-hospital mortality, and at follow-up: information on survival status of the patients was collected during hospitalization and assessed 3 months after discharge by telephone interview to patients or caregivers.
|
Up to 3 months
|
Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
The Alzheimer's Disease Test (AD8)
Délai: Up to 3 months
|
The Alzheimer's Disease Test (AD8) is a brief informant-based measure that reliably distinguishes individuals with very mild dementia from those with normal cognition [Galvin et al., 2005).
The AD8 is composed of 8 items.
In the initial development of the AD8, using a cutoff of 2 or greater on the AD8 to predict dementia gave the most desirable combination of sensitivity (85%) and specificity (86%).
|
Up to 3 months
|
|
Assessment of Performance in Basic Activities of Daily Living: Barthel Index
Délai: Up to 3 months
|
The Barthel Index is a scale used for the assessment of performance in basic activities of daily living [Mahoney & Barthel, 1965) that considers 10 basic functions and yields a score of 0-100.
A higher score is associated with a greater likelihood of being able to live at home with a degree of independence following discharge from hospital.
It was categorized according to four cutoff points, which are as follows: 75-100 as reference (no-mild disability), 50-74 (moderate disability), 25-49 (severe disability), and 0-24 (completely dependent).
|
Up to 3 months
|
|
Instrumental Activities of Daily Living (IADL)
Délai: Up to 3 months
|
Lawton and Brody score was determined as a function of patient status 2 weeks before admission, based on the patient's medical history or information supplied by a caregiver.
IADL assesses ability to use the telephone, to shop, to use transport, to cook, to do housework, to take medication and to handle finances.
0 indicates total dependence and the maximum score (8) indicates total independence.
|
Up to 3 months
|
|
EuroQoL 5-domain for Health-related quality of life (EQ-5D) (EuroQoL Group, 1990).
Délai: Up to 3 months
|
This well-established generic instrument which measures health-related QoL has five domains: mobility, self-care, pain/discomfort, usual activities, and anxiety/depression.
The respondents also rate their own health today on a visual analogue scale from 100 (best imaginable health state) to 0 (worst imaginable health state).
The data can be presented descriptively as a health profile, and a single index utility score can be calculated.
|
Up to 3 months
|
|
The Quality of Life in Alzheimer's disease (QOL-AD)
Délai: Up to 3 months
|
- The QOL-AD, a 13-item scale (range, 13 to 52, with higher scores indicating a better QOL) was used to examine AD-specific QOL (Logsdon et al., 1999).
It has 13 items covering the domains of physical health, energy, mood, living situation, memory, family, marriage, friends, chores, fun, money, self, and life as a whole.
These are scored on a 4-point Likert scale, ranging from 1 (poor) to 4 (excellent), with a possible total range from 13 to 52.
The scale obtains separate ratings of the patient's QoL from both the patient and the caregiver, where available.
These scores can be combined into a single score, weighting the person with dementia's own QoL score twice as heavily as the caregiver's.
Early studies by Logsdon et al. (1999) suggest it to have good internal consistency, construct validity, and test-retest reliability.
In this study, only the caregiver of the person with dementia's self-reported QoL was evaluated.
|
Up to 3 months
|
|
Caregiver's burden was evaluated with the Zarit Scale
Délai: Up to 3 months
|
A reduced Zarit scale is useful to identify caregiver burden in dementias (with a sensitivity 98,5% and specificity of 94,7%), and it is also easy to use (Gort et al., 2010).
Fields explored with the 4 items Zarit scale were overburden (items 9 and 14), irritability (item 5) and the self-care (item 2).
These are scored on a 5-point Likert scale, ranging from 1 (never) to 4 (most times).
Higher score, more burden.
(in online material)
|
Up to 3 months
|
|
Diagnosis
Délai: Up to 3 months
|
Up to 3 months
|
|
|
Body Mass Index (BMI)
Délai: Up to 3 months
|
Up to 3 months
|
|
|
Nutritional status
Délai: Up to 3 months
|
Blood test which included serum albumin, total cholesterol, electrolytes, total lymphocyte count was made.
|
Up to 3 months
|
|
Level of consciousness: The Glasgow Coma Scale (GCS)
Délai: Up to 3 months
|
The Glasgow Coma Scale (GCS) was employed to measure consciousness (Teasdale & Jennett, 1974).
In this scale the normal state merits a score of 15, and as level of consciousness deteriorates, the score becomes less.
(Teasdale & Jennett, 1974).
|
Up to 3 months
|
|
Pressure Ulcer risk: the Braden Scale and the Gosnell Scale were employed.
Délai: Up to 3 months
|
The Braden Scale (Bergstrom et al., 1987) is a summated rated scale comprised of 6 subscales: sensory perception, mobility, activity, moisture, nutrition, and friction and shear.
The 6 subscales are rated from 1 to 4, except the friction and shear subscale, which is rated from 1 to 3. Each numerical rating has a definition of patient characteristics to evaluate when assigning a score.
A total of 6 to 23 points is possible.
|
Up to 3 months
|
Collaborateurs et enquêteurs
C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.
Parrainer
Collaborateurs
Les enquêteurs
- Chercheur principal: Inmaculada Moro, MSc, Hospital Galdakao-Usansolo
Dates d'enregistrement des études
Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.
Dates principales de l'étude
Début de l'étude
1 janvier 2012
Achèvement primaire (Réel)
1 janvier 2015
Dates d'inscription aux études
Première soumission
18 juin 2015
Première soumission répondant aux critères de contrôle qualité
23 juin 2015
Première publication (Estimation)
26 juin 2015
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Estimation)
26 juin 2015
Dernière mise à jour soumise répondant aux critères de contrôle qualité
23 juin 2015
Dernière vérification
1 juin 2015
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- 2012111139
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