Patient characteristics, behavior, and discharge locations of patients with dementia and very severe challenging behavior

OBJECTIVES: To gain insights into the characteristics, behavior, and discharge location of patients with dementia and very severe challenging behavior admitted to highly specialized units that are specialized in the diagnostics and treatment of this patient group.

METHOD: In this observational study, 11 units participated from 2020 - 2023. Measurements included demographics; dementia type; severity of cognitive decline; presence of delirium; location before admission; compulsory admission; medical history; drug use; and behavior during the first 2 weeks of admission, assessed by the Cohen-Mansfield Agitation Inventory and the Neuropsychiatric Inventory Questionnaire.

RESULTS: 127 patients (67.7% males) participated. Nine in ten patients had moderately severe or severe cognitive decline. Behavior was rather heterogeneous, with agitation, general restlessness and verbal aggression present in 70% or more. Agitation was severely or extremely distressful for nursing staff in relation to one in four patients. Half of the patients were discharged to a regular dementia special care unit (DSCU), one in ten could not be discharged, and one-third died during their stay.

CONCLUSIONS: Despite heterogenous and highly prevalent behaviors of patients, about half of the patients could be discharged to DSCUs after treatment in a highly specialized unit. Future studies should explore whether and how treatment is effective.