[A clinical analysis of elderly dementia patients with physical comorbidities].

AIM: To investigate the current status of elderly dementia patients with physical illnesses and identify optimal care strategies for this growing population. METHODS: This retrospective study included elderly dementia patients who (i) received in-patient treatment for a physical comorbidity at the dementia ward of the Juntendo Tokyo Koto Geriatric Medical Center, and (ii) who were discharged from April 2009 to March 2011. RESULTS: The study population was 390 patients (144 males, 246 females), with a mean [±SD] age of 80.5 [±8.1] years. Two hundred thirteen of the patients had Alzheimer's disease; the remaining 177 had other types of dementia. The comorbidities necessitating admission were: malignant neoplasms (n=65), respiratory conditions (n=57), genitourinary conditions (n=50), trauma or fracture (n=41), and other (n=177). Among the 239 subjects who were hospitalized from their homes and who were discharged alive, 157 (65.7%) returned to their homes. The hospital stays of patients who were discharged were significantly shorter (P<0.000) and their N-ADL scores were significantly better at admission (P<0.013) and at discharge (P<0.000). The proportion of subjects who were capable of oral ingestion was significantly higher among the patients who were discharged to their homes (P<0.025). The subjects who lived in their homes alone at the time of hospitalization were significantly less likely to be discharged to their homes (P<0.018). CONCLUSIONS: Elderly dementia patients should ideally return home after hospitalization for comorbid illnesses. This was facilitated by minimizing their hospital stay. During in-patient treatment, efforts should be made to maintain their N-ADL levels and support their oral intake.

[Study of discharge support in dementia cases].

AIM: The goal of this study was to clarify how the post-discharge support by a full time psychiatric social worker (PSW) in a dementia ward affected the discharge status of dementia patients. METHODS: Patients who were discharged from a dementia ward were examined for hospitalization, post-discharge status, nutrition methods, treatment drugs, and relationship with discharge support performed by the PSW. RESULTS: A total of 192 cases met the requirements for this examination, and approximately half (94, 49.0%) of these patients had Alzheimer disease. Fifty-two patients (32.3%) moved to home care. Forty-five patients visited our hospital for treatment, while 17 visited other medical institutions for treatment. Thirty-four patients (17.7%) moved to other medical institutions, and the remaining 96 patients (50.0%) entered other institutions. About half of these patients entered insurance care facilities for the elderly, and the number of entered cases decreased in the order of special elderly nursing homes, paid homes for the elderly, and group homes. The highest mean support frequency per case was more than 50 occasions and 800 minutes for a paid home for the elderly. This support decreased in the order of special elderly nursing homes, insurance care facilities, and group homes. Cases treated at other medical institutions had the shortest hospitalization, but these cases had a greater mean support frequency than the cases treated at our hospital. The lowest mean support frequency was for oral meal intake while the highest mean support frequency was for nourishment by gastrostomy, with a significant difference between both (P<0.01). Only for cases that entered insurance care facilities for the elderly was there significantly more support frequency for cases that took donepezil hydrochloride than cases that took other drugs (P<0.03). CONCLUSIONS: After discharge from a dementia ward, the PSW spent a significant amount of time on discharge support, and this discharge support was indispensable. Hospitalization at a medical institution or admission to facilities was associated with a higher degree of discharge support than home care. Furthermore, patients who were hospitalized at a long-term medical treatment institution, or those who entered an insurance care facility for the elderly, needed frequent support for drug administration.