Challenging symptoms of persons living with dementia in integrated medical and care institutions: A multilevel analysis.

Abstract

This study aimed to explore the potential factors associated with challenging symptoms. A questionnaire survey was conducted on 823 persons living with dementia in 13 integrated medical and care institutions in Hunan Province, China. The challenging symptoms score was 5.0 (2.0, 8.0). Higher symptom scores were associated with longer dementia duration (b=0.17, P=0.030), moderate dementia (b=1.19, P<0.001), significantly impaired activities of daily living (b=3.20, P=0.012), and risk for abuse (b=3.53, P<0.001). At the caregiver level, anxiety (b=0.12, P=0.044) and the greater the number of persons living with dementia in their care (b=0.24, P<0.001) also increased challenging symptoms. In addition, we reported for the first time the unintended effects of the older adult's cerebrovascular disease (b=-0.83, P=0.007) and psychotropic medications use (b=1.17, P<0.001). The older adult's multiple adverse health-related conditions and the caregiver's negative emotions have an impact on challenging symptoms. The role of psychotropic medications warrants further study.