Dementia in Long Term Care Facilities: Telemedicine for the Management of Neuropsychiatric Symptoms

Dementia in Long Term Care Facilities: Telemedicine for the Management of Neuropsychiatric Symptoms.

Telemedicine may facilitate adequate treatment of Neuropsychiatric symptoms (NPS) by identifying underlying causes and tailoring a treatment plan (pharmacological or non-pharmacologic treatments including provision of staff education and support, training in problem solving, and targeted therapy directed at the underlying causes for specific behaviors).

During a 6-months period, patients will be included in both arms, whenever they present a disruptive NPS that requires a specialist consultation based on the long-term care facility (LTCF) staff judgment. In the intervention group, a telemedicine (TM) consultation between the LTCF staff (medical and nurse staff) and the Memory Center from the University Hospital, will occur at inclusion (T0). Then, a second TM consultation will occur at 1 month (T1). In the control group management of NPS will be done as usual care. In both groups, patients' parameters such as non-programmed hospitalizations and/or consultations due to disruptive NPS, psychotropic drugs use, and health costs, will be evaluated at inclusion, 1 month and at 2 months. Acceptability of the TM among the LTCF staff will be assessed during the study in the intervention group.

The two university hospitals are composed of a group of institutions for elderly people located near Toulouse and Limoges.

Inclusion Criteria:

• patient aged 65 or more, with a dementia diagnosed by a specialist or the general practitioner;
• patient presenting with a disruptive NPS as defined in French Haute Autorité de Santé (HAS) recommendations (2009), that requires a specialist consultation based on the LTCF staff judgment;
• informed and written consent by the patient or the legal representative or the reliable person when appropriate;
• general practitioner agreement.

Exclusion Criteria:

• patient's life expectancy less than 6 months;
• Non agreement of study participation of patients or legal representative or the reliable person when appropriate.