The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry · 2026
Psychiatric Hospitalization Precipitants and Outcomes in a Comprehensive Dementia Care Program.
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Lee David R, Endo Andrew S, Kalbasi Tahmineh R, Turner Maurice, Jimenez Ivette A, Serrano Katherine Sy, Centeno Andrea, Reuben David B
Аннотация
OBJECTIVES: 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.
DESIGN: Retrospective cohort study.
SETTING: UCLA Alzheimer's and Dementia Care Program.
PARTICIPANTS: Patients hospitalized at the UCLA Resnick Neuropsychiatric Hospital (NPH).
MEASUREMENTS: 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).
RESULTS: 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.
CONCLUSION: 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.
DESIGN: Retrospective cohort study.
SETTING: UCLA Alzheimer's and Dementia Care Program.
PARTICIPANTS: Patients hospitalized at the UCLA Resnick Neuropsychiatric Hospital (NPH).
MEASUREMENTS: 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).
RESULTS: 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.
CONCLUSION: 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.