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. 2021 Dec;36(12):1959-1969.
doi: 10.1002/gps.5604. Epub 2021 Aug 27.

Impact of agitation in long-term care residents with dementia in the United States

Howard Fillit  1 , Myrlene S Aigbogun  2 , Patrick Gagnon-Sanschagrin  3 , Martin Cloutier  3 , Mikhaïl Davidson  3 , Elizabeth Serra  3 , Annie Guérin  3 , Ross A Baker  2 , Christy R Houle  4 , George Grossberg  5
Affiliations

Impact of agitation in long-term care residents with dementia in the United States

Howard Fillit et al. Int J Geriatr Psychiatry. 2021 Dec.

Abstract

Objectives: To describe characteristics and compare clinical outcomes including falls, fractures, infections, and neuropsychiatric symptoms (NPS) among long-term care residents with dementia with and without agitation.

Methods: A cross-sectional secondary analysis of administrative healthcare data was conducted whereby residents with dementia residing in a long-term care facility for ≥12 months were identified from the AnalytiCare LLC database (10/2010-06/2014) and were classified into mutually exclusive cohorts (Agitation Cohort or No-Agitation Cohort) based on available agitation-related symptoms. Entropy balancing was used to balance demographic and clinical characteristics between the two cohorts. The impact of agitation on clinical outcomes was compared between balanced cohorts using weighted logistic regression models.

Results: The study included 6,265 long-term care residents with dementia among whom, 3,313 were included in the Agitation Cohort and 2,952 in the No-Agitation Cohort. Prior to balancing, residents in the Agitation Cohort had greater dementia-related cognitive impairment and clinical manifestations compared to the No-Agitation Cohort. After balancing, residents with and without agitation, respectively, received a median of five and four distinct types of medications (including antipsychotics). Further, compared to residents without agitation, those with agitation were significantly more likely to have a recorded fall (OR = 1.58), fracture (OR = 1.29), infection (OR = 1.18), and other NPS (OR = 2.11).

Conclusions: Agitation in long-term care residents with dementia was associated with numerically higher medication use and an increased likelihood of experiencing falls, fractures, infections, and additional NPS compared to residents without agitation, highlighting the unmet need for effective management of agitation symptoms in this population.

Keywords: agitation; dementia; falls; fractures; infections; long-term care; medication use; neuropsychiatric symptoms.

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Conflict of interest statement

Patrick Gagnon‐Sanschagrin, Martin Cloutier, Mikhaïl Davidson, Elizabeth Serra, and Annie Guérin are employees of Analysis Group, Inc., a consulting company that has received consultancy fees from Otsuka Pharmaceutical Development and Commercialization, Inc., to conduct this study. Myrlene Sanon Aigbogun was an employee of Otsuka Pharmaceutical Development and Commercialization, Inc. at the time the study was conducted. Ross A. Baker is an employee of Otsuka Pharmaceutical Development and Commercialization, Inc. Christy R. Houle is an employee of Lundbeck Pharmaceuticals.

Figures

FIGURE 1
FIGURE 1
Study design. A period of continuous stay was defined as an ongoing residential stay with no discharge lasting longer than 14 days. Considering residents may have short discharge episodes for non‐medical reasons, a short discharge episode of 14 days or less was not considered the end of a continuous stay. *MDS assessments are indicated for illustrative purposes only
FIGURE 2
FIGURE 2
Sample selection. Variables of interest were gender, race, and an indicator of agitation. MDS, Minimum Data Set version 3.0
FIGURE 3
FIGURE 3
Treatment patterns–balanced cohorts. Treatment types were based on GPI classification and are mutually exclusive. The number of distinct medication types is based on the following medication classes: APs, antidepressants, antidementia drugs, antianxiety drugs, narcotics, antiepileptics, antihypertensives, lipid‐lowering drugs, antidiabetics, antihistamines, anticoagulants, antiplatelet drugs, pain control drugs, anti‐Parkinson drugs, hypnotics, antiemetic drugs, stimulants, and anticholinergics. AP, antipsychotic
FIGURE 4
FIGURE 4
Impact of agitation on study outcomes − balanced cohorts. Odds ratios were estimated using weighted logistic regression models. An odds ratio >1 indicates that residents with agitation are more likely to experience the outcome compared to residents without agitation. Other behavioral symptoms include depression, anxiety, delusion, and hallucinations. OR, odds ratio; CI, confidence interval; * Significant at the 5% level
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