A multicomponent unit‐based approach for hospital care of older adults with behavioral and psychological symptoms of dementia

BACKGROUND: Persons with Alzheimer's disease and related dementias (ADRD) are more frequently hospitalized and often experience behavioral and psychological symptoms of dementia (BPSD). This study describes a dementia-focused medical unit that aims to improve the management of BPSD in hospitalized patients with ADRD. OBJECTIVES: The objective of the present paper is to: (1) describe the dementia-focused medical unit; (2) describe the population admitted to the dementia-focused medical unit; (3) present management strategies of BPSD prior to and post unit transfer; and (4) describe patient (e.g., mobility, goals-of-care, mortality) and hospital metrics (e.g. LOS, 30-day hospital readmission) for the unit. The remainder of the abstract is the same. METHODS: A 10-bed dementia-focused medical unit was created in a large academic center in New York. The unit consisted of geographic cohorting, dementia care education for staff (e.g., de-escalation, redirection), and environmental modifications (e.g., common area). An interprofessional team conducted daily rounds that focused on the 4Ms (mobility, mentation, matters most, and medication management), and early discharge planning. RESULTS: A total of 165 hospitalized patients were admitted to the dementia-focused medical unit between July 1, 2024, and October 28, 2024. The mean age of patients was 84.7 years old (SD = 9.0); 67.9% (n = 112) had a documented history of dementia, of which 96.4% (n = 108) had at least moderate dementia (FAST stage 6A+). A comparison of BPSD management before and after transfer demonstrated a significant reduction in constant observation (30.9% vs. 0.0%, p < .001), benzodiazepines (13.3% vs. 6.7%, p = .035), and "as-needed" antipsychotics (29.7% vs. 20.0%, p = .009). While as-needed antipsychotics decreased, there was an increase in scheduled antipsychotics (18.2% vs. 28.5%, p < .001), indicating a shift from reactive to proactive medication management. CONCLUSION: There is an urgent need to improve the management of BPSD in hospitalized older adults with ADRD. Dementia-focused medical units are an innovative strategy that requires further investigation.