Functional Recovery and Mortality in Hospitalized Patients With Dementia and Severe Neuropsychiatric Symptoms: A...

To determine whether functional status in older adults with dementia and severe neuropsychiatric symptoms (NPS), particularly functional improvement during specialised psychogeriatric hospitalisation, is associated with better survival.

A retrospective cohort study was conducted using data from the Matia Psychogeriatric Hospitalisation Study (PHS-Matia), including 2,283 patients aged ≥60 years hospitalised between 2011 and 2024. Functional status was assessed with a modified Barthel Index (BI) at preadmission, admission, and discharge. Psychotropic burden was measured using the Psychotropic Drug Burden Index (pDBI). Survival was analysed with Kaplan-Meier (KM) curves and Cox regression models, while functional recovery was assessed using linear mixed-effects models.

The median age was 83 years, and 51.8% were female. Functional recovery during hospitalization was significant (median BI improvement: +13, p <0.001). Increased pDBI was associated with an 87% lower mortality (HR: 0.13, 95% CI, [0.09-0.21], p <0.001). Among psychotropic subgroups, a higher antipsychotic pDBI correlated with greater functional recovery (coefficient: 2.65, 95% CI, [1.12-4.17], p = 0.001). The Spanish version of the Mini-Mental State Examination (MEC-35) ≥15 was associated with lower mortality (HR: 0.23, p <0.001).

Functional improvement during hospitalization is a key predictor of survival in older adults with dementia and severe neuropsychiatric symptoms (NPS). The observed association between increased pDBI and reduced mortality challenges conventional views on psychotropic use, warranting further research. These findings underscore the importance of an individualized, symptom-driven approach to treatment in this vulnerable population.