Impact of Systematic Tracking of Dementia Cases on the Rate of Hospitalization in Emergency Care Units

Not Applicable

Completed

• Conditions: Dementia in Nursing Home

• Registration Number: NCT01569997
• Lead Sponsor: University Hospital, Toulouse

Brief Summary

Introduction: Epidemiological data show that in France only half of patients with Alzheimer disease are currently diagnosed in the general population. The absence of early diagnosis of dementia reduces the opportunities of patients to receive optimal care. One of the consequences of undiagnosed dementia is inadequate use of emergency care units.

The main objective: The main aim of this study is to evaluate the impact of a systematic case-finding procedure of dementia cases in nursing homes through a MDTM on the rate of hospitalization in emergency care units.

Secondary objectives:

To assess the impact of systematic tracking of dementia cases on the:

* Quantity and quality of drug-prescription

* Appropriateness of hospitalizations

* Prevalence of neuropsychiatric symptoms

* Dependency

* Quality of life

* Burden of nursing staff working conditions

* Planning of specific therapeutic measures

* Overall health care costs

Detailed Description

This is a multicentre, cluster randomized study comparing two parallel groups:

* Intervention group: nursing homes whose residents benefit from MDTM to identify the cases of dementia and to propose an adequate care project

* Control group: nursing homes whose residents continue to benefit from usual care In each group, 1000 elderly subjects aged over 60 years without documented diagnosis of dementia will be included and monitored for a period of 18 months.

Information about the main and secondary aims will be collected monthly through online questionnaires.

Study Timeline

• Study Start: 2010-05
• Study First Submitted: 2011-07-04
• Study First Submitted QC: 2012-03-30
• Study First Posted: 2012-04-04
• Primary Completion: 2013-09
• Study Completion: 2013-09
• Status Verified: 2020-07
• Last Update Submitted: 2020-07-28
• Last Update Posted: 2020-07-29

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 1428

Inclusion Criteria

• Residents of both sex, aged 60 years or over

• Residents living in a nursing home participating in the study

• Residents living in the nursing home for 30 days or more

• Residents without diagnosed and documented dementia, identified as follows:

  • residents not identified by the French Healthcare system as suffering from dementia (ALD 15)
  • residents not benefiting from a specific care program or a specialized follow-up for dementia
  • residents for whom there is no appropriate investigation for dementia diagnosis in medical records
  • residents not taking specific drugs for dementia (Cholinesterase inhibitors and/or Memantine)

• Residents and their GP having received information about the study

• Residents and their GP having expressed their agreement to participate in the study

Exclusion Criteria

• Residents aged less than 60 years

• Residents not living in a nursing home participating in study

• Residents living in nursing home for less than 30 days

• Residents with diagnosed and documented dementia, identified as follows:

  • residents Identified by the French Healthcare system as suffering from dementia (ALD 15)
  • residents benefiting from specific care programme or specialized follow-up for dementia
  • residents for whom there is appropriate investigation for dementia diagnosis in medical records
  • residents taking specific drugs for dementia (Cholinesterase inhibitors and/or Memantine)

• Residents and/or their GP who received no information about the study

• Residents and/or their GP having expressed their opposition to participate in the study

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Incidence of hospitalizations in emergency care units	18 months	Monthly collection during follow-up (18 months)

Secondary Outcome Measures

Name	Time	Method
Number of days off work by nursing staff	18 months	Monthly collection during follow-up (18 months)
Presence of advanced care planning in patients medical records	Baseline visit, 18 months	Advanced care planning will be checked through behavioural disosders, transfer to hospital intensive care and resuscitation
Overall healthcare costs	18 months	Monthly collection during follow-up (18 months)
Prevalence of antipsychotic prescription	Baseline visit, 4 months, 18 months
Incidence of inappropriate hospitalizations	18 months	Monthly collection during follow-up (18 months)
Dependency evaluated by AGGIR and IADL-4 items	Baseline visit, 18 months
Quality of life evaluated by QOL-AD	Baseline visit, 18 months
Number of nursing staff's time off work	18 months	Monthly collection during follow-up (18 months)
Prevalence of neuropsychiatric symptoms evaluated by NPI-nursing staff version	Baseline visit, 18 months

Trial Locations

Locations (90)

Centre de Gerontologie Pompeyrie Chu Agen; 🇫🇷 Agen, France

Ehpad Maison de Retraite Louise Anceau; 🇫🇷 Albi, France

Ehpad Maison de Retraite Olga Ducoudray; 🇫🇷 Albi, France

Ehpad Mr "Les Jardins de Jouvence"; 🇫🇷 Albi, France

Mapad La Renaudie Ch Albi; 🇫🇷 Albi, France

Ehpad Les Ajoncs D'Or; 🇫🇷 Allaire, France

Ehpad Maison de Retraite Hl Ax Les Thermes; 🇫🇷 Ax-les-Thermes, France

Ehpad Marie Lehman; 🇫🇷 Balma, France

Ehpad Kerdigemer; 🇫🇷 Brest, France

Ehpad Residence Ker-Heol; 🇫🇷 Brest, France

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