Measuring change in clinical profiles between hospital admission and discharge and predicting living arrangements at discharge for aged patients presenting behavioral and psychological symptoms of dementia

• A majority of psychogeriatric inpatients with BPSD are discharged to nursing homes.
• Clinical profiles vary significantly between admission and discharge.
• BPSD-affective profile and gender at discharge predict return to home.
• BPSD-functional and BPSD-psychotic profiles at discharge predict transfer to acute care or death.

BackgroundThe clinical courses of psychogeriatric inpatients presenting behavioral and psychological symptoms of dementia, between their admission and discharge, have been poorly documented. Based upon our previously elaborated profiles of psychogeriatric patients, this study aimed to describe these courses and to explore whether changing clinical profiles could predict living arrangements at discharge.MethodsRetrospective data were collected on 397 patients with dementia and hospitalized from 2011 to 2014 in French-speaking Switzerland. Patients were classified on admission and at discharge using four clinical profiles (BPSD-affective, BPSD-functional, BPSD-somatic, and BPSD-psychotic). Multinomial logistic regression analyses were used to identify predictors of living arrangements at discharge. Age, gender, marital status, living arrangements on admission, and clinical profile on admission and discharge, were used as potential predictors.ResultsOf the patients classified as BPSD-functional or BPSD-affective on admission, 70.18% and 73.48%, respectively, had the same classification at discharge. However, 45.74% of patients classified as BPSD-somatic on admission were discharged with a BPSD-functional profile, and 46.15% of inpatients classified as BPSD-psychotic on admission were discharged as BPSD-affective (χ2(9) = 128.8299; p < 0.000). At discharge, 64.99% of all patients were admitted to a nursing home. The significant predictors of return to home were: being male (OR = 0.96; 95% CI: 0.93–0.99) and BPSD-affective profile (OR = 1.95; 95% CI: 1.08–3.54. Significant predictors of transfer to acute care or death were: BPSD-somatic (OR = 12.98; 95% CI: 1.96–85.91) or BPSD-psychotic profile (OR = 13.53; 95% CI: 1.65–111.05).DiscussionThis study provides new information concerning the clinical course of older psychogeriatric inpatients using profiles derived from clinically sensitive profiles.