Clinical trial NCT01569997: Impact of Systematic Tracking of Dementia Cases on the Rate of Hospitalization in Emergency Care Units
Official title: 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
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Dementia in Nursing Home
Keywords: Dementia
emergency hospitalization
nursing home
multidisciplinary meeting
cognitive decline
disability
residents
facilities
long term care unit
health policy
general practitioner
prevention
Lead sponsor: University Hospital, Toulouse
Sponsor class: OTHER
First posted: 2012-04-04
Enrollment: 1428
Sex: ALL
Minimum age (years): 60
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: PREVENTION

Brief summary: 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: 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.

Eligibility criteria: 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

Primary outcomes:
measure: Incidence of hospitalizations in emergency care units
timeFrame: 18 months
Secondary outcomes:
measure: Prevalence of antipsychotic prescription
timeFrame: Baseline visit, 4 months, 18 months
measure: Incidence of inappropriate hospitalizations
timeFrame: 18 months
measure: Prevalence of neuropsychiatric symptoms evaluated by NPI-nursing staff version
timeFrame: Baseline visit, 18 months
measure: Dependency evaluated by AGGIR and IADL-4 items
timeFrame: Baseline visit, 18 months
measure: Quality of life evaluated by QOL-AD
timeFrame: Baseline visit, 18 months
measure: Number of nursing staff's time off work
timeFrame: 18 months
measure: Number of days off work by nursing staff
timeFrame: 18 months
measure: Presence of advanced care planning in patients medical records
timeFrame: Baseline visit, 18 months
measure: Overall healthcare costs
timeFrame: 18 months
Other outcomes:
Locations:
city: Agen
country: France
facility: Centre de Gerontologie Pompeyrie Chu Agen
city: Albi
country: France
facility: Ehpad Maison de Retraite Louise Anceau
city: Albi
country: France
facility: Ehpad Maison de Retraite Olga Ducoudray
city: Albi
country: France
facility: Ehpad Mr "Les Jardins de Jouvence"
city: Albi
country: France
facility: Mapad La Renaudie Ch Albi
city: Allaire
country: France
facility: Ehpad Les Ajoncs D'Or
city: Ax-les-Thermes
country: France
facility: Ehpad Maison de Retraite Hl Ax Les Thermes
city: Balma
country: France
facility: Ehpad Marie Lehman
city: Brest
country: France
facility: Ehpad Kerdigemer
city: Brest
country: France
facility: Ehpad Residence Ker-Heol
city: Catus
country: France
facility: Ehpad Residence Saint Astier
city: Caussade
country: France
facility: Mapa de L'Hopital Local de Caussade
city: Ceignac
country: France
facility: Ehpad Maison de Retraite Ste Marthe
city: Cepet
country: France
facility: EHPAD Résidence Castelgirou
city: Clermont L'herault
country: France
facility: Ehpad Leon Ronzier Joly
city: Colomiers
country: France
facility: Ehpad Themis Lasplanes
city: ERR
country: France
facility: Ehpad Maison de Retraite Joseph Sauvy
city: Escalquens
country: France
facility: Ehpad Residence Borde Haute Promo-Accueil
city: Firmi
country: France
facility: Mapad "Firmi"
city: Fleurance
country: France
facility: Ehpad Hopital Local Fleurance
city: Foix
country: France
facility: Ehpad Mr Bellissen Chi Du Val D'Ariege
city: Guer
country: France
facility: Ehpad Dr Robert
city: L'union
country: France
facility: Ehpad Residence Grand'Maison
city: La Roquebrussanne
country: France
facility: Ehpad Residence Provencale Medicafrance
city: Lamorlaye
country: France
facility: Ehpad Residence Clairefontaine
city: Lavaur
country: France
facility: Mapad Ch Lavaur
city: Le Conquet
country: France
facility: Ehpad Saint Reah Hir
city: Le Mee Sur Seine
country: France
facility: Ehpad Residence D'Automne de La Ferme
city: Lescure d'Albigeois
country: France
facility: Ehpad Maison de Retraite "Les Charmilles"
city: Lezat Sur Leze
country: France
facility: Residence Le Parc
city: Lherm
country: France
facility: Ehpad La Cheneraie
city: Lisle Sur Tarn
country: France
facility: Ehpad Mr Lagrange
city: Lourdes
country: France
facility: Mapad Labastide Ch Lourdes
city: Marchiennes
country: France
facility: Ehpad Emile Dubois
city: Marciac
country: France
facility: Ehpad Les Mille Soleils
city: Marines
country: France
facility: Ehpad Et. Public Gerontologie de Marines
city: Marseille
country: France
facility: AP-HM Hôptal La Timone Service de Pédiatrie Mutidisciplinaire
city: Mauvezin
country: France
facility: Ehpad Maison Retraite Hl Mauvezin
city: Mazamet
country: France
facility: Ehpad Maison de Retraite Saint Joseph
city: Mazeres
country: France
facility: Ehpad Maison de Retraite Privee de Mazeres
city: Mirande
country: France
facility: Ehpad-Maison Retraite Hl Mirande
city: Moissac
country: France
facility: Ehpad Chis Castelsarrasin-Moissac
city: Montauban de Luchon
country: France
facility: Ehpad Era Caso
city: Montauban
country: France
facility: Ehpad Maison Retraite Ch Montauban
city: Montpellier
country: France
facility: Ehpad Ma Maison
city: Montredon Labessonnie
country: France
facility: Ehpad Maison de Retraite Sainte Agnes
city: Mèze
country: France
facility: Ehpad L'Ecrin Des Sages
city: Nailloux
country: France
facility: Ehpad L'Acacia
city: Naucelle
country: France
facility: Logements Foyer La Fontanelle
city: Nice
country: France
facility: Ehpad Fondation Pauliani
city: Nice
country: France
facility: Ehpad Les Noisetiers
city: Nice
country: France
facility: Ehpad Residence Ancilla
city: Ossun
country: France
facility: Ehpad Mais de Retraite Saint-Joseph
city: Pamiers
country: France
facility: Ehpad Mr Bariol Chi Du Val D'Ariege
city: Panazol
country: France
facility: Ehpad Residence Le Parc
city: Paris
country: France
facility: AP-HP Hôpital Necker Enfants Malades Service d'endocrinologie pédiatrique - 149 route de Sèvres
city: Paris
country: France
facility: Ehpad Furtado Heine
city: Paris
country: France
facility: Ehpad Julie Siegfried
city: Paris
country: France
facility: Ehpad La Pirandelle
city: Paris
country: France
facility: Ehpad Residence Anselme
city: Paris
country: France
facility: Ehpad Residence Belleville
city: Paris
country: France
facility: Ehpad Residence Herold
city: Paris
country: France
facility: Ehpad Residence Oceane
city: Paris
country: France
facility: Ehpad Tiers Temps Paris
city: Pierre Buffiere
country: France
facility: Ehpad Residence Adeline
city: Reims
country: France
facility: Ehpad Residence D'Automne Medica-France
city: Rieux Volvestre
country: France
facility: Ehpad L'Oree Du Bois
city: Rodez
country: France
facility: Ehpad Residence Saint-Amans
city: Saint Bonnet
country: France
facility: Ehpad Le Jardin Des Loges
city: Saint Lys
country: France
facility: Ehpad Residence Themis La Joie de Vivre
city: Saint Orens de Gameville
country: France
facility: Ehpad A Labouilhe
city: Saint Remy de Provence
country: France
facility: Ehpad Public de Saint-Remy de Provence
city: Sousceyrac
country: France
facility: Ehpad Les Bruyeres
city: St Gaudens
country: France
facility: Ehpad Maison Retraite Orelia Ch St Gaudens
city: St Martory
country: France
facility: Ehpad Genevriers
city: Tarbes
country: France
facility: Ehpad Maison de Retraite Chic Tarbes Vic
city: Tarbes
country: France
facility: Ehpad Residence "Le Doyenne Du Carmel"
city: Tinteniac
country: France
facility: Ehpad Sainte Anne
city: Toulouse
country: France
facility: Ehpad de La Cote Pavee
city: Toulouse
country: France
facility: Ehpad Gaubert
city: Toulouse
country: France
facility: Ehpad Mr Henri Iv
city: Toulouse
country: France
facility: Ehpad Pierre Ducis
city: Toulouse
country: France
facility: Ehpad Residence La Cotonniere
city: Toulouse
country: France
facility: Ehpad Residence Le Clos Des Carmes
city: Toulouse
country: France
facility: Ehpad Residence Marguerite
city: Toulouse
country: France
facility: Ehpad Residence Saint-Simon
city: Toulouse
country: France
facility: Usld Domaine de La Cadene
city: Valence-d'albigeois
country: France
facility: Ehpad Umt
city: Villefranche de Lauragais
country: France
facility: Ehpad Maisonneuve
city: Villemur Sur Tarn
country: France
facility: Ehpad Saint-Jacques
Study officials:
affiliation: EHPAD MAISON DE RETRAITE SAINT JOSEPH - MAZAMET
name: Pierre ALLAN, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: EHPAD MA MAISON MONTPELLIER
name: Véronique ARNAUD-ULLIET, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Rolland Y, Tavassoli N, de Souto Barreto P, Perrin A, Laffon de Mazieres C, Rapp T, Hermabessiere S, Tournay E, Vellas B, Andrieu S. Systematic Dementia Screening by Multidisciplinary Team Meetings in Nursing Homes for Reducing Emergency Department Transfers: The IDEM Cluster Randomized Clinical Trial. JAMA Netw Open. 2020 Feb 5;3(2):e200049. doi: 10.1001/jamanetworkopen.2020.0049.