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Agitation and Depression in Frail Nursing Home Elderly Patients With Dementia

Treatment Characteristics and Service Use

Received December 3, 2001; revised May 16, 2002; accepted May 20, 2002. From Aging Services Research, New Hampshire–Dartmouth Psychiatric Research Center, Department of Psychiatry, Dartmouth Medical School, Lebanon, NH (SJB,ARD) and the Institute For Clinical Outcomes Research, Salt Lake City, UT (SDH,RJS). Also from New York University (EF), The Degge Group, Ltd., Arlington, VA (JKJ), Needham and Company, New York, NY (MM), Division of Geriatrics and Long-Term Care, Washington Hospital Center, Washington, DC (GAT), and Strategic R&D, Ross Products Division, Abbott Laboratories, Columbus, OH (ACV). Address correspondence to Dr. Bartels, New Hampshire–Dartmouth Psychiatric Research Center, 2 Whipple Place, Suite 202, Lebanon, NH 03766. e-mail: stephen.j.bartels{at}dartmouth.edu

OBJECTIVE: The authors describe characteristics, treatment, and acute service use associated with agitation and depression in dementia. METHODS: Authors used retrospective chart review of symptoms, physician-level prescribing, and acute service use over 3 months for 2,487 physically frail older residents, including 1,836 with dementia, (mean age: 79.8 years) in 109 long-term care facilities, describing differences between uncomplicated dementia and three mutually exclusive subgroups of complicated dementia, including dementia with agitation-only, dementia with depression-only, and dementia with mixed agitation and depression. RESULTS: Compared with the other subgroups, frail elderly patients with dementia complicated by mixed agitation and depression have the highest rate of hospitalization, the greatest number of medical diagnoses, and the greatest medical severity, and they receive the greatest number of psychiatric medications. Depression in dementia (either alone or mixed with agitation) was associated with greater prevalence of pain. CONCLUSIONS: Dementia complicated by mixed agitation and depression accounts for over one-third of complicated dementia and is associated with multiple psychiatric and medical needs, intensive pharmacological treatment, and use of high-cost services. Research should target this complex, high-risk group to develop appropriate diagnostic criteria and effective treatment interventions.

Key Words: Depression • Dementias (general) • Long-Term Care

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