Institutionalization, dementia

Controlled health services trials of effect of changes in institutional policies effecting the patient milieu, such as staffing, lighting, organized patient activities, medication protocols, etc., on the sleep of institutionalized dementia patients. 

Dziegielewski, S. F. (1990). The institutionalized dementia relative and the family member relationship. Unpublished doctoral dissertation, Florida State University, Tallahassee. 

Institutionalization has been identified as one of the main cost drivers in the care of people with dementia (Holmes et al, 1998 Souetre et al, 1999), and the savings achieved by delaying the onset of institutionalization for these patients are expected to offset the additional dmg acquisition costs. 

The behavioral and emotional complications of dementia such as agitation, depression, and psychosis are often the most troublesome aspect of the illness. They can alienate the family members who are trying to provide care and often lead exhausted families to institutionalize these patients whom they would otherwise prefer to keep at home. 

Many behavioral problems can complicate dementia, and these problems can strike at any phase of the illness. It is often this aspect of the illness that is most distressing to both the patients and their caregivers. Behavioral disturbance is the most frequent cause of hospitalization and long-term institutionalization for patients who would otherwise be at home with their families. Therefore, treating these behavioral problems not only provides emotional relief for dementia patients and their families but can also lower the tremendous economic burden of dementia. The key, as we have said before, is to control the behavioral disturbance without worsening the dementia. (See Table 10.6)... 

Many AD patients, especially those in advanced stages of the disorder, suffer from serious behavioral and psychiatric symptoms of dementia (acronym BPSD), making their own life and that of their family or professional caregivers difficult. Studies in institutionalized AD patients with BPSD indicate... 

Goldberg R, Goldberg J. Antipsychotics for dementia-related behavioral disturbances in elderly institutionalized patients, din Geriatt 1996 4 58-68. 

The rationale and design of the first multicenter study of (-)-deprenyl in the treatment of Alzheimer s disease using novel clinical outcomes was published by Sano et al. in 1996 and the results of this study were published 1 year later (Sano et al. 1997). The primary outcome involved the time that elapses until the occurrence of any of the following death, institutionalization, loss of the ability to perform basic activities of daily living, or severe dementia. There were significant delays in the time taken for such primary outcomes to occur in patients treated with (-)-deprenyl. The authors concluded that in patients with moderately severe impairment from Alzheimer s disease, treatment with (-)-deprenyl slows the progression of the disease. 

Over 30% of patients with dementia develop a group of secondary behavioral disturbances, including depression, hallucinations and delusions, agitation, insomnia, and wandering. Because these secondary symptoms impair patients functions, increase their need for supervision, and often influence the decision to institutionalize them, the control of these symptoms is a priority in managing AD. 

Witlox, J., Eurelings, L.S.M., de Jonghe, J.F.M. et al. (2010) Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia A meta-analysis. Journal of the American Medical Association 304 (4), 443-451. 

---