The Characteristics and Outcomes of People with Dementia in Inpatient Mental Health Care: A Review

Figures & data

Figure 1. Study selection procedure.

Table 1. Patients in specialist dementia units.

Author (Date) Country	Measure of level of distress behavior	Average number medical conditions per patients	Psychotropic medication	Average length of stay	Discharge destination	Mortality
Akpaffiong et al. (1999) USA	Cohen-Mansfield White patients: 53.4 admission and 37.9 discharge Black patients: 48.9 admission and 38.8 discharge	White patients 4.51 Black patients 4.45	White patients: Antidepressants 72% Antipsychotics 76% Black patients: Antidepressants 60% Antipsychotics 87%	White 34 days Black 32 days	Not reported	Not reported
Aziz et al. (2018) UK	Not reported	2015 6.23 2016 5.73	85–88% patients receiving polypharmacy	Not reported	Not reported	Not reported
Chan et al. (2009) USA	Not reported	4	Mean number of medications per patient: 7.8 admission and 7.9 discharge	14 days	Not reported	Not reported
Edmans et al. (2021) UK	Not reported	Not reported	Percentage of admissions prescribed; Risperidone 38.9–57.3% Olanzapine 10.0–16.5% Quetiapine 7.8–22.2% Lorazepam 43.7–88.9% Diazepam 9.7–23.3%	Between 80.6–125.1 days	General hospital 8.0–22.1% Residential home 19.8–67.2% Home 10.6–50.0%	4.0–8.0%
Haw, Stoffels, Das Purkayastha & Sudad (2015) UK	BPSD was rated as severe in 68–89% cases by the treating clinician	Not reported	Percentage of patients prescribed antipsychotics: 2007–56%, 2012 76% Most commonly used antipsychotics: Olanzapine 39–50% Quetiapine 19–25% Risperidone 21–23%	Not reported	Not reported	Not reported
Koskas et al. (2011)* France	Neuropsychiatric Inventory conducted on admission but not discharge. 49–80% rated as displaying agitation or aggressiveness.	3–5	Not reported	Not reported	29–35% discharged home.	Not reported
Neville, Boyle & Ballion (1999) UK	Behavior problems accounted for 52% of the reasons given for admission. 34% reported behavior problems were aggression. 27% admissions had 3 or more behviour problems reported.	Not reported	Not reported	42 days (range 1–418). Length of stay for people not discharged to usual place of residence was significantly longer.	39.3% discharged to their usual place of residence. 34.8% discharged home. 15.2% residential home. 31.2% nursing home.	9.4%
Pongan et al., (2017) France	Neuropsychiatric Inventory conducted on admission and discharge by care team. Mean 37.33–40.37 at admission. Mean 26.20–30.37 at discharge.	2.87	Mean number of psychotropic medications per patient: 2.12–2.20	Not reported	61.4% discharged home. 38.6% discharged into nursing home.	4.3% 3 months after discharge.
Rouch et al. (2017) France	Neuropsychiatric Inventory conduced at baseline and follow up. Mean 48.6 at baseline and 47.1 at follow up.	Not reported	Mean number of psychotropic medications: 1.99 at baseline, 2.28 at discharge and 2.22 at 1 year follow up.	Not reported	At 12 month follow up, 66.0% living in community and 35.8% living in nursing home.	22.6% died during the study: 5.9% during admission, 5.9% before 3 month follow up, 4.5% between 3–6 month follow up and 6.3% between 6–12 month follow up.
Saidlitz, Sourdet, Voisin & Vella (2017) France	Neuropsychiatric Inventory conducted before admission, at admission, at discharge and at follow up. 39.0 at admission and 26.6 at discharge. 25.0 at follow up.	Not reported	Mean number of psychotropics at discharge was 2.5.	39.9 days	15.6% home; 63.8% nursing home; 4.0% psychiatry; 14.6% other hospital; 2% died	2.0%
Wilkins et al. (2019) USA	Not reported	2.4	Not reported	29 days.	77.8% Home 11.1% Assisted living 11.1% Nursing care	All died within 6 months of discharge. Average time from discharge to death was 39 days.

Table 2. Patients with dementia in mixed older adult units.

Author (Date) Country	Measure of level distress behaviors	Average number of medical conditions per patient	Psychotropic medication	Average length of stay	Discharge destination	Mortality
Aartsma et al, (2019) South Africa	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported
Alanen et al., (2015) Finland	Neuropsychiatric Inventory 34.6 at admission and 19.5 at discharge.	Not reported	51.7% prescribed antipsychotics on admission, 71.9% prescribed antipsychotics on discharge.	Not reported	Not reported	Not reported
Brackenridge, Courtnay, Jha & Lawrence (1997) UK	Not reported	Not reported	Not reported	36 days	14% Home 38% Residential care 43% Nursing care	0
Chan, Chiu, Lam & Leung (2002) Hong Kong	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported
Davis, Holman & Brameld (2000) Australia	Not reported	Not reported	Not reported	Not reported	Not reported	12% by one year follow up.
Djernes et al., (1998) Denmark	Sandman’s Multidimensional Dementia Evaluation Program conducted at admission and discharge. Points for behavioral disorders. 0–9 36% admission, 47% discharge 10–19 46% admission, 39% discharge 20–29 7% admission, 14% discharge 30–39 11% admission, 0% discharge	1.3 somatic disorders	41–47% prescribed neuroleptics, 12–9% prescribed anxiolytics, 12–18% prescribed hypnotics and 0–3% prescribed antidepressants	Not reported	Not reported	Not reported
Ekiz, Videler & Alphen (2020) Netherlands	Neuropsychiatric Inventory – Severity subscale 9.82 at admission and 6.66 at discharge. Cohen-Mansfield Agitation Inventory 50.24 at admission and 45.71 at discharge.	Not reported	Not reported	Not reported	Not reported	Not reported
Freynet & Wrigley (1997) Ireland	70% with dementia admitted due to severe behavioral disturbance.	Not reported	Not reported	17 days	40% Home 44% Nursing home 4% Acute hospital	1%
Harrison, Kernutt & Piperogluo (1988) Australia	Not reported	75% suffered from a significant physical disorder	Not reported	32 days.	Not reported	6%
Hassett, George, Harrigan (1999) Australia	Not reported	Not reported	Not reported	Non-English-speaking background: 35.6 days English-speaking background: 36.8 days	Not reported	Not reported
Ismail et al., (2015) Canada	Reasons for admission: Threat or danger to self: 36% Threat or danger to others: 46% Inability to care for self: 89% Problem with addiction: 8% Specific psychiatric symptoms: 86%	Not reported	Not reported	38.13 days.	Not reported	Not reported
Koskas et al. (2011)* France	Neuropsychiatric Inventory conducted on admission but not discharge. 49–80% rated as displaying agitation or aggressiveness.	3–5	Not reported	Not reported	29–35% discharged home.	Not reported
Livingston et al. (2020) UK	Not reported	92% had at least one comorbidity	72% were prescribed at least one antipsychotic	Not reported	Not reported	15%
Manu et al., (2013) USA	Not reported	3.8 42.3% patients with dementia had a significant deterioration requiring emergency transfer during admission.	Not reported	Not reported	Not reported	Not reported
Mei-Tai & Myers (1986) USA	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported
McMinn and Hinton (2000) Australia	38% admitted due to aggression. 38% admitted due to wandering and aggression.	Not reported	Not reported	Not reported	53% long-stay psychogeriatric unit 46% nursing home	Not reported
Moss, Wilson, Harrigan & Ames (1995) Australia	Not reported	Not reported	Not reported	29 days	Not reported	0
Nahas et al., (1997) USA	Not reported	3.6	46% received antipsychotics	41.7 days (14–147)	Not reported	Not reported
Nirodi and Mitchell (2002) UK	Not reported	Not reported	55.7% received antipsychotics	Not reported	Not reported	Not reported
Paschali et al., (2017) Germany	62% patients reported as aggressive using SOAS-R had dementia	Not reported	Not reported	48.3 days	Not reported	Not reported
Pitkanen, Alanen, Kampman & Leinonen (2018) Finland	During admission, Neuropsychiatric Index score decreased from 33.9 to 18.2	Not reported	76.5% received antipsychotics	36 days	30.5% home 9.0% sheltered accommodation 14.4% residential care home 19.8% primary care unit 26.3% other	Not reported
Rockwood, Stolee & Brahim (1991) Canada	People with dementia accounted for; 69% reported aggression 95% reported wandering 60% reported carelessness 41% messy eating	Not reported	Not reported	Not reported	5% community 41% long-term care facility 40% chronic care unit	14%
Sajatovic, Friedman, Sabharwal & Bingham (2004) USA	Not reported	3.0	76.5% received antipsychotics	11.1 days.	Not reported	Not reported
Smith, Hassett, Harrigan and Fortune (2010) Australia	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported

Table 3. Dementia subtypes reported in patients in inpatient mental health settings.

Subtype of dementia	Prevalence rates
Alzheimer’s disease	5.8%-75%
Vascular dementia	8.1%-63.4%
Mixed dementia	2.5%-44.4%
Lewy body dementia	2.4%-12%
Parkinson’s disease dementia	2.4%-8%
Alcohol related dementia	2.2%-15%

Akpaffiong, M., Kunik, M. E., Hale, D., Molinari, V., & Orengo, C. (1999). Cross‐cultural differences in demented geropsychiatric inpatients with behavioral disturbances. International Journal of Geriatric Psychiatry, 14(10), 845–850. doi:10.1002/(SICI)1099-1166(199910)14:10<845::AID-GPS34>3.0.CO;2-H

 PubMed Web of Science ®Google Scholar

Aziz, V. M., Hill, N., & Kumar, S. (2018). Completed audit cycle to explore the use of the STOPP/START toolkit to optimise medication in psychiatric in-patients with dementia. BJPsych Bulletin, 42(1), 37–41. doi:10.1192/bjb.2017.10

 PubMed Web of Science ®Google Scholar

Chan, V. T., Woo, B. K., Sewell, D. D., Allen, E. C., Golshan, S., Rice, V., … Daly, J. W. (2009). Reduction of suboptimal prescribing and clinical outcome for dementia patients in a senior behavioral health inpatient unit. International Psychogeriatrics, 21(1), 195–199. doi:10.1017/S104161020800803X

 PubMed Web of Science ®Google Scholar

Edmans, B. G., Wolverson, E., Dunning, R., Slann, M., Russell, G., Crowther, G., … Underwood, B. R. (2021). Inpatient psychiatric care for patients with dementia at four sites in the United Kingdom. International Journal of Geriatric Psychiatry, 37(2), 1-4.

 PubMed Web of Science ®Google Scholar

Haw, C., Stoffels, M., Purkayastha, D. D., & Sudad, S. (2015). Antipsychotics for behavioral and psychiatric symptoms of dementia: A reaudit in a specialist inpatient service. International Psychogeriatrics, 27(1), 171–172. doi:10.1017/S1041610214001288

 PubMed Web of Science ®Google Scholar

Koskas, P., Feugeas, M. C. H., Saad, S., Belqadi, S., Daraux, J., & Drunat, O. (2011). Management of behavioral and psychological symptoms of dementia in a dedicated psychogeriatric unit: A pilot experience. Alzheimer Disease & Associated Disorders, 25(2), 184–186. doi:10.1097/WAD.0b013e3181fa2f81

 PubMed Web of Science ®Google Scholar

Neville, P., Boyle, A., & Baillon, S. (1999). A descriptive survey of acute bed usage for dementia care in old age psychiatry. International Journal of Geriatric Psychiatry, 14(5), 348–354. doi:10.1002/(SICI)1099-1166(199905)14:5<348::AID-GPS915>3.0.CO;2-B

 PubMed Web of Science ®Google Scholar

Pongan, E., Dorey, J.-M., Krolak-Salmon, P., Federico, D., Sellier, C., Auguste, N., … Rouch, I. (2017). Predictors of discharge destinations and three-month evolution of patients initially hospitalized in a cognitive behavioral unit. Journal of Alzheimer’s Disease, 60(4), 1259–1266. doi:10.3233/JAD-170419

 PubMed Web of Science ®Google Scholar

Rouch, I., Pongan, E., Trombert, B., Fabre, F., Auguste, N., Sellier, C., … Mouchoux, C. (2017). One-year evolution of behavioral and psychological symptoms of dementia in patients initially hospitalized in cognitive behavioral units: The EVITAL prospective cohort. Journal of Alzheimer’s Disease, 57(1), 147–155. doi:10.3233/JAD-161023

 PubMed Web of Science ®Google Scholar

Saidlitz, P., Sourdet, S., Voisin, T., & Vellas, B. (2017). Management of behavioural symptoms of dementia in a specialized unit care. Psychogeriatrics, 17(2), 81–88. doi:10.1111/psyg.12193

 PubMed Web of Science ®Google Scholar

Wilkins, J. M., Goldstein, E. K., & Forester, B. P. (2019). Characteristics of hospice referrals from an inpatient geriatric psychiatry unit. The American Journal of Geriatric Psychiatry, 27(2), 162–166. doi:10.1016/j.jagp.2018.11.011

 PubMed Web of Science ®Google Scholar

Aartsma, D. P., Groenewald, E., Koen, L., Potocnik, F., & Niehaus, D. (2019). A clinical profile of inpatient admissions to the psychogeriatric unit at Stikland hospital. South African Journal of Psychiatry, 25(1), 1–5. doi:10.4102/sajpsychiatry.v25i0.1344

 Google Scholar

Alanen, H.-M., Pitkänen, A., Suontaka-Jamalainen, K., Kampman, O., & Leinonen, E. (2015). Acute psychogeriatric inpatient treatment improves neuropsychiatric symptoms but impairs the level of functioning in patients with dementia. Dementia and Geriatric Cognitive Disorders, 40(5–6), 290–296. doi:10.1159/000431087

 PubMed Web of Science ®Google Scholar

Brackenridge, P., Courtnay, K., Jha, A., & Lawrence, R. (1997). Does hospital admission affect dependency levels of elderly psychiatric patients? International Journal of Geriatric Psychiatry, 12(7), 750–752. doi:10.1002/(SICI)1099-1166(199707)12:7<750::AID-GPS627>3.0.CO;2-O

 PubMed Web of Science ®Google Scholar

Chan, S. S., Chiu, H. F., Lam, L. C., & Leung, V. P. (2002). Prevalence of dementia with Lewy bodies in an inpatient psychogeriatric population in Hong Kong Chinese. International Journal of Geriatric Psychiatry, 17(9), 847–850. doi:10.1002/gps.716

 PubMed Web of Science ®Google Scholar

Davis, P. S., Holman, C. D. A. J., & Brameld, K. (2000). Gender differences in survival of 234 patients referred to a psychogeriatric service. International Journal of Geriatric Psychiatry, 15(11), 1061–1069. doi:10.1002/1099-1166(200011)15:11<1061::AID-GPS280>3.0.CO;2-9

 PubMed Web of Science ®Google Scholar

Djernes, J. K., Gulmann, N. C., Abelskov, K. E., Juul-Nielsen, S., & Sørensen, L. (1998). Psychopathologic and functional outcome in the treatment of elderly inpatients with depressive disorders, dementia, delirium, and psychoses. International Psychogeriatrics, 10(1), 71–83. doi:10.1017/S104161029800516X

 PubMedGoogle Scholar

Ekiz, E., Videler, A. C., & Van Alphen, S. P. (2020). Feasibility of the cognitive model for behavioral interventions in older adults with behavioral and psychological symptoms of dementia. Clinical Gerontologist, 45(4), 1–12.

 PubMed Web of Science ®Google Scholar

Freyne, A., & Wrigley, M. (1997). Acute inpatient admissions in a community oriented old age psychiatry service. Irish Journal of Psychological Medicine, 14(1), 4–7. doi:10.1017/S0790966700002810

 Web of Science ®Google Scholar

Harrison, A. W., Kernutt, G. J., & Piperoglou, M. V. (1988). A survey of patients in a regional geriatric psychiatry inpatient unit. Australian & New Zealand Journal of Psychiatry, 22(4), 412–417. doi:10.3109/00048678809161350

 PubMed Web of Science ®Google Scholar

Hassett, A., George, K., & Harrigan, S. (1999). Admissions of elderly patients from English-speaking and non-English-speaking backgrounds to an inpatient psychogeriatric unit. Australian & New Zealand Journal of Psychiatry, 33(4), 576–582. doi:10.1080/j.1440-1614.1999.00537.x

 PubMed Web of Science ®Google Scholar

Ismail, Z., Arenovich, T., Granger, R., Grieve, C., Willett, P., Patten, S., & Mulsant, B. H. (2015). Associations of medical comorbidity, psychosis, pain, and capacity with psychiatric hospital length of stay in geriatric inpatients with and without dementia. International Psychogeriatrics, 27(2), 313–321. doi:10.1017/S1041610214002002

 Web of Science ®Google Scholar

Livingston, G., Rostamipour, H., Gallagher, P., Kalafatis, C., Shastri, A., Huzzey, L., … Marston, L. (2020). Prevalence, management, and outcomes of SARS-CoV-2 infections in older people and those with dementia in mental health wards in London, UK: A retrospective observational study. The Lancet Psychiatry, 7(12), 1054–1063. doi:10.1016/S2215-0366(20)30434-X

 PubMed Web of Science ®Google Scholar

Manu, P., Grudnikoff, E., Khan, S., Kremen, N. J., Greenwald, B. S., Kane, J. M., & Correll, C. U. (2013). Medical outcome of patients with dementia in a free-standing psychiatric hospital. Journal of Geriatric Psychiatry and Neurology, 26(1), 29–33. doi:10.1177/0891988712473799

 PubMed Web of Science ®Google Scholar

Mei-Tal, V., & Meyers, B. S. (1986). Empirical study on an inpatient psychogeriatric unit: Diagnostic complexities. The International Journal of Psychiatry in Medicine, 15(2), 91–109. doi:10.2190/APUG-89N0-X5F6-6032

 Web of Science ®Google Scholar

McMinn, B. G., & Hinton, L. (2000). Confined to barracks: The effects of indoor confinement on aggressive behavior among inpatients of an acute psychogeriatric unit. American Journal of Alzheimer’s Disease, 15(1), 36–41. doi:10.1177/153331750001500106

 Google Scholar

Moss, F., Wilson, B., Harrigan, S., & Ames, D. (1995). Psychiatric diagnoses, outcomes and lengths of stay of patients admitted to an acute psychogeriatric unit. International Journal of Geriatric Psychiatry, 10(10), 849–854. doi:10.1002/gps.930101006

 Web of Science ®Google Scholar

Nahas, Z., Kunik, M. E., Orengo, C. A., Molinari, V., & Workman, R. (1997). Depression in male geropsychiatric inpatients with and without dementia: A naturalistic study. Journal of Affective Disorders, 46(3), 243–246. doi:10.1016/S0165-0327(97)01430-4

 PubMed Web of Science ®Google Scholar

Nirodi, P., & Mitchell, A. (2002). The quality of psychotropic drug prescribing in patients in psychiatric units for the elderly. Aging & mental health, 6(2), 191–196. doi:10.1080/13607860220126817

 PubMed Web of Science ®Google Scholar

Paschali, M., Kamp, D., Reichmann, C., Jaenner, M., Lange-Asschenfeldt, C., & Supprian, T. (2018). A systematic evaluation of impulsive–aggressive behavior in psychogeriatric inpatients using the staff observation aggression scale-revision (SOAS-R). International Psychogeriatrics, 30(1), 61–68. doi:10.1017/S1041610217001600

 PubMed Web of Science ®Google Scholar

Pitkänen, A., Alanen, H.-M., Kampman, O., & Leinonen, E. (2018). Outcome of neuropsychiatric symptoms and daily functioning of patients with dementia treated on an acute psychogeriatric ward. Nordic Journal of Psychiatry, 72(7), 521–525. doi:10.1080/08039488.2018.1532021

 PubMed Web of Science ®Google Scholar

Rockwood, K., Stolee, P., & Brahim, A. (1991). Outcomes of admission to a psychogeriatric service. The Canadian Journal of Psychiatry, 36(4), 275–279. doi:10.1177/070674379103600407

 PubMed Web of Science ®Google Scholar

Sajatovic, M., Friedman, S. H., Sabharwal, J., & Bingham, C. R. (2004). Clinical characteristics and length of hospital stay among older adults with bipolar disorder, schizophrenia or schizoaffective disorder, depression, and dementia. Journal of Geriatric Psychiatry and Neurology, 17(1), 3–8. doi:10.1177/0891988703258821

 PubMed Web of Science ®Google Scholar

Smith, B., Hassett, A., Harrigan, S., & Fortune, T. (2010). A profile of inpatient admissions to an aged psychiatry service in Victoria. Australasian Psychiatry, 18(2), 146–151. doi:10.3109/10398560903314112

 PubMed Web of Science ®Google Scholar

Data Availability Statement

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.