Preliminary Data from an Advanced Dementia Consult Service: Integrating Research,Education, and Clinical Expertise

Hospitalized individuals with advanced dementia often receive care that is of limited clinical benefit and inconsistent with preferences. An advanced dementia consultation service was designed, and a pre and post pilot study was conducted in a Boston hospital to evaluate it. Geriatricians and a palliative care nurse practitioner conducted consultations, which consisted of structured consultation, counseling and provision of an information booklet to the family, and postdischarge follow‐up with the family and primary care providers. Individuals aged 65 and older with advanced dementia who were admitted were identified, and consultations were solicited using pop‐ups programmed into the computerized provider order entry (POE) system. In the initial 3‐month period, 24 subjects received usual care. In the subsequent 3‐month period, consultations were provided to five subjects for whom they were requested. Data were obtained from the electronic medical record and proxy interviews (admission, 1 month after discharge). Mean age of the combined sample (N = 29) was 85.4, 58.6% were from nursing homes, and 86.2% of their proxies stated that comfort was the goal of care. Nonetheless, their hospitalizations were characterized by high rates of intravenous antibiotics (86.2%), more than five venipunctures (44.8%), and radiological examinations (96.6%). Acknowledging the small sample size, there were trends toward better outcomes in the intervention group, including greater proxy knowledge of the disease, better communication between proxies and providers, more advance care planning, lower rehospitalization rates, and fewer feeding tube insertions after discharge. Targeted consultation for advanced dementia is feasible and may promote greater engagement of proxies and goal‐directed care after discharge.     

Suicidal Thought in the Adolescent: Exploring the Relationship Between Known Risk Factors and the Presence of Suicidal Thought

PROBLEM: The purpose of this retrospective study was to explore the relationship between recognized risk factors for suicidal thought and the presence or absence of self‐reported suicidal thought. METHODS: This study was conducted through the secondary analysis of data obtained from a larger, prospective, cluster‐randomized intervention study. A subset of 817 recruits between the ages of 17 and 19 was included in this study. FINDINGS: A personal history of mental health/emotional problems and a decreased sense of belonging made unique contributions to predicting the presence of suicidal thought. CONCLUSIONS: The development of interventions to increase sense of belonging may be a key to reducing suicidal thought during stressful events.