Unclear Benefits for Dementia Screenings at Nursing Homes

OBTN, May 2009, Volume 0,

Investigators in a new study find little difference between cognitive screenings and standard care in limiting emergency department visits from nursing home residents.

Yves Rolland, MD, PhD

Cognitivescreenings may not be needed to limit emergency department visits fromnursing homeresidents.

A team, led by Yves Rolland, MD, PhD, Regional Aging and Addiction Prevention Team (ERVPD), examined whether systematic dementia screenings of nursing home residents in conjunction with multidisciplinary team meetings results in a lower rate of emergency department transfers when compared with usual care.

The cluster randomized clinical trial included 1428 residents in 64 public and private nursing homes in France.

To be included in the study, nursing home residents must be at least 60-years old without diagnosed or documented dementia. The patients must also not be bedridden, living in the nursing home for at least 1 month at inclusion, and had a life expectancy greater than 12 months.

The median age of study participants was 84.7.

Residents were ultimately followed for up to 18 months, with the final study visit completed by 1042 residents (73.0%).

The main reason for early discontinuation was death (318 participants [22.7%]).

The investigators found interventions did not reduce the risk of emergency department transfers during the 12-month follow-up period.

Of the study’s population, 16.2% of residents in the intervention group were transferred to emergency departments, while 12.8% of patients in the control group were transferred during the 12-month follow-up (odds ratio, 1.32; 95% CI, 0.83-2.09;P = 0.24).

The team compared an intervention group, which consisted of a pair of nursing homes that set up 2 multidisciplinary team meetings to identify residents with dementia and discuss an appropriate care plan with a control group that consisted of nursing homes that continued their standard practice procedures.

“This study failed to demonstrate that systematic screening for dementia in NHs resulted in fewer ED transfers,” the authors wrote. “The findings do not support implementation of multidisciplinary team meetings for systematic dementia screening of all NH residents, beyond the national recommendations for dementia diagnosis, to reduce ED transfers.”

Dementia often goes underdiagnosed in nursing home populations, which could potentially result in inappropriate care and high rates of emergency department transfers.

Nursing home patients also commonly face multiple underlying morbidities and can be susceptible to potentially avoidable adverse events such as falls, weight loss, delirium, side effects of polymedication, and behavioral disturbances.

Recently, theUnited States Preventative Services Task Force(USPSTF) said there is not enough evidence to evaluate the harms or benefits ofcognitive impairmentscreenings in older, community-dwelling adults.

The recommendations comes at a time when the neurology community continues to push for early and consistent cognitive screening, especially in those at risk for Alzheimer disease or dementia, as clinical research and drug development focuses on early intervention.

Notably, the USPSTF’s recommendation, which is unchanged since its last iteration in 2014, applies to adults age 65 and older who do not have recognized signs or symptoms of cognitive impairment, which it defines as significant decline in 1 or more cognitive domains that interfere with a person’s independence and daily activities.

Given the lack of high-quality evidence supporting or against cognitive screening in this population, the USPSTF encourages health care providers to be watchful for early signs and symptoms and to screen when appropriate.

While systematic screenings for dementia is recommended by expert groups and guidelines, underrecognition of the disease has been repeatedly reported in Europe and in the US.

Underdiagnosing dementia has resulted in a high hospitalization, particularly with emergency department admissions.

The study, “Systematic Dementia Screening by Multidisciplinary Team Meetings in Nursing Homes for Reducing Emergency Department Transfers,” was published online inJAMA Network Open.