Factors associated with length of stay in patients from residential aged care facilities admitted for behavioural and psychological symptoms of dementia

Objective: To determine factors affecting the length of stay (LOS) in patients from residential aged care facilities (RACFs) admitted for behavioural and psychological symptoms of dementia (BPSD). 

Methods: Medical records for RACF patients admitted to Flinders Medical Centre between January and December 2018 were reviewed. For patients admitted with BPSD, demographics, clinical characteristics, admission characteristics and outcomes were extracted. Key outcomes were LOS and admission to a subacute unit (psychogeriatric or geriatric) for ongoing care. Factors influencing LOS and subacute admission were explored. 

Results: The average LOS was 21.7 days and median LOS 10.5 days. Younger age, prior Dementia Behaviour Management Advisory Service review, psychogeriatrician assessment, inpatient treatment order and increased number of Code Blacks (hospital code for violent behaviour) were associated with a longer LOS and subacute admission. Being women and being bed-bound were associated with shorter admission and direct discharge. Opioid use was associated with shorter admission. Use of benzodiazepine and higher dose, higher antipsychotic dose, use of antidepressant or mood stabilisers were associated with subacute admission. The presence of reversible causes was associated with direct discharge. 

Conclusions: Certain clinical characteristics may be associated with LOS in patients with BPSD from RACFs. This information may help in the development of strategies to prevent acute presentation to hospital, minimise LOS and create pathways for improved management.