Effectiveness of multidisciplinary consultation for older adults with Alzheimer's disease in response to acute situations

To avoid emergency hospitalisation of elderly people with dementia, which often has negative consequences, there are two main approaches: consultation and day care hospitalisation. However, it usually takes some time to arrange a consultation, and geriatric day hospital facilities are over-subscribed and costly. In 2014, we created a “consultation de crise” (CMC) programme in our sector of Paris, with several special features: a short wait for an appointment, a consultation involving an interdisciplinary team, a weekly multi-disciplinary meeting to reassess complex patients, and the possibility of a rapid referral to a social worker. To determine whether the CMC programme is a useful way to minimise hospitalization among elderly community-dwelling populations, and to examine its design criteria. Retrospective review of all CMC requests from April 2014 to January 2017 in comparison with consultation at the Memory Center and geriatric day hospital. CMC patients were followed up at one month after their assessment. Mini Mental Status and Neuro Psychiatric Inventory vary significantly different between the 3 groups. The CMC group had the lowest score on the MMSE scale and the highest for NPI. After one month, 60% of CMC patients were still at home (33 patients) or in the same nursing home (6 patients) and about 23% were hospitalized during the follow-up period. Our study showed the potential value of a less expensive multidisciplinary consultation, and confirmed that collaborative care resulted in a significant improvement in the quality of care. Pour éviter l’hospitalisation en urgence de personnes âgées atteintes de démence, qui a souvent des conséquences négatives, il existe deux approches principales : la consultation et l’hospitalisation de jour. Il faut généralement un long délai pour organiser une consultation, et les hôpitaux de jour de gériatrie sont surchargés et coûteux. En 2014, nous avons créé un programme de « consultation de crise » (CMC) dans notre secteur de Paris, avec plusieurs caractéristiques particulières : un délai court de rendez-vous, une consultation impliquant une équipe interdisciplinaire, une réunion pluridisciplinaire hebdomadaire pour réévaluer les patients complexes, et la possibilité d’une rapide intervention d’un travailleur social. Pour déterminer si la CMC est un moyen utile pour réduire l’hospitalisation chez les personnes âgées, nous avons réalisé une étude rétrospective de toutes les demandes de CMC d’avril 2014 à janvier