Psychiatric Hospitalization Precipitants and Outcomes in a Comprehensive Dementia Care Program

Characterize the precipitants and outcomes of psychiatric hospitalizations among patients enrolled in a comprehensive dementia care program and identify factors associated with discharge to higher-level residential setting.

Retrospective cohort study.

UCLA Alzheimer's and Dementia Care Program.

Patients hospitalized at the UCLA Resnick Neuropsychiatric Hospital (NPH).

Precipitating reasons for hospitalization, patient demographic and clinical characteristics, hospitalization-level characteristics, and caregiver relationship. Discharge to higher-level residential settings (e.g., assisted living, nursing home). Change in scheduled Central Nervous System (CNS)-active medications (antipsychotics, antidepressants, and sedative/hypnotics).

There were 180 psychiatric hospitalizations among 150 patients, with a median age of 79 years (IQR, 73-85) at admission and MMSE score of 17 (IQR, 12-24) at first hospitalization. Agitation was the most common precipitating reason for hospitalization (n = 127, 71%). Median length of stay was 14 days (IQR, 9-26); 54 (30%) resulted in discharge to a higher-level residential setting. Agitation as the precipitant for hospitalization (aOR, 4.7; 95% CI, 1.7-12.9, p = 0.003) and male sex (aOR, 2.3; 95% CI, 1.0-5.5, p = 0.049) were associated with higher odds of discharge to a higher-level setting. Most hospitalizations resulted in no change in the number of scheduled CNS-active medications (e.g., 69% had no change in the number of scheduled antipsychotics), while escalation occurred in 19%-28%, depending on medication class.

Psychiatric hospitalization precipitated by agitation or involving male patients was often followed by transition to higher-level residential care. Future studies should evaluate whether earlier outpatient psychiatry involvement and proactive placement planning can reduce hospitalization and subsequent placement changes.