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

Study Overview
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Brief Summary
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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

Detailed Description
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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.

Official Title
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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

Conditions
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Dementia in Nursing Home

Intervention / Treatment
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* Other: MultiDisciplinary Team Meetings (MDTM)


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Intervention group<br>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)<br>* 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...)<br>|
| No Intervention: control group<br>Control group: nursing homes whose residents continue to benefit from usual care | |

What is the study measuring?
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Primary Outcome Measures

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

Secondary Outcome Measures

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

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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residents, Dementia, emergency hospitalization, nursing home, multidisciplinary meeting, cognitive decline, disability, facilities, long term care unit, health policy, general practitioner, prevention