Predictors of Discharge Destinations and Three-Month Evolution of Patients Initially Hospitalized in a Cognitive Behavioral Unit

Article type: Research Article

Authors: Pongan, Elodie^{a; b; *} | Dorey, Jean-Michel^c | Krolak-Salmon, Pierre^b | Federico, Denis^b | Sellier, Claire^d | Auguste, Nicolas^e | Fabre, Florence^e | Laurent, Bernard^a | Trombert-Paviot, Béatrice^{f; g} | Rouch, Isabelle^{a; b}

Affiliations: [a] Neurology Unit, CM2R, CHU de Saint Etienne, Hôpital Nord, Saint Etienne, France | [b] Geriatrics Unit, CM2R, Hospices civils de Lyon, Hôpital des Charpennes, Villeurbanne, France | [c] Psychiatry Unit, Centre hospitalier le Vinatier, Bron, France | [d] Psychiatry Unit, Centre hospitalier St Jean de Dieu, Lyon, France | [e] Geriatrics Unit, CM2R, CHU de Saint Etienne, Hôpital de la Charité, Saint-Etienne, France | [f] Public Health and Medical Information, CHU de Saint Etienne, Saint Etienne, France | [g] EA 4607 SNA- EPIS PRES Lyon, Université Jean Monnet, Saint Etienne cedex, France

Correspondence: [*] Correspondence to: Elodie Pongan, Centre Mémoire de Ressources et de Recherche, Neurology unit, University Hospital of Saint-Etienne, 42055 Saint Etienne, France. Tel.: +33 4 77 12 73 97; E-mail: elodie.pongan@chu-lyon.fr.

Abstract: Background:Previous studies showed that a third of patients living at home entered an institution after hospitalization in Cognitive and Behavioral Units (CBUs). Objective:The main objective of this study was to identify predictors of discharge destination for these patients. The secondary objective was to estimate whether institutionalization can have an impact on a patient’s long-term prognosis. Methods:The study population was selected from the EVITAL study and included 140 participants living at home before hospitalization in CBUs. Factors favoring nursing-home admission were investigated and the impact of discharge destinations (i.e., home or nursing home) on patients’ prognosis was examined. Results:Institutionalized patients were more likely to be women (F = 4.7; p = 0.03), with a higher dementia severity (F = 9.82; p = 0.007), often living alone (F = 19.69; p = 0.001), with a caregiver other than spouse (F = 8.93; p = 0.003), and with a higher patient quality of life (QoL) according to the caregiver (F = 11.73; p = 0.001). When using multivariate logistic linear regressions, we showed a relationship between marital status (OR = 0.19, 95% CI: 0.08–0.43, p < 0.001), dementia severity (OR = 0.15, 95% CI: 0.03–0.79, p = 0.03), QoL (OR = 0.88, 95% CI: 0.79–0.98, p = 0.017), and institutionalization. At three months, a higher overall rate of rehospitalization (F = 12.21; p < 0.001) and rehospitalization for behavioral and psychological symptoms of dementia (F = 6.76; p = 0.006) were observed for patients staying at home after CBU discharge. Conclusion:Our study allows for a better understanding of the institutionalization risk factors of the patients hospitalized in CBUs. Identification of these factors could help clinicians to better support patients and to help the transition to be smoother. Moreover, our results suggest that prognosis of institutionalized patients is not unfavorable when compared with patients staying at home.

Keywords: Alzheimer’s disease and related disorders, behavioral and psychological symptoms of dementia, caregivers, institutionalized patients, nursing home placement, predictors

DOI: 10.3233/JAD-170419

Journal: Journal of Alzheimer's Disease, vol. 60, no. 4, pp. 1259-1266, 2017