Unit Description

Acute care units for patients with Alzheimer disease are still rare but are developing rapidly. The Alzheimer Acute Care Unit of the Toulouse Hospital Authority (Unité de Soins Aigüs Alzheimer des Hôpitaux de Toulouse, or SACU) has been developed from an acute care unit for internal medicine and geriatrics, without increased costs. It has 20 beds : 8 for agitated patients, 12 for quiet patients or those in the early stages of the disease. About one-third of patients are admitted for diagnostic evaluation, one-third for complications related to the disease, and one-third for intercurrent disorders. Between 1996 and 1999, admissions to the unit have significantly increased : + 47% in 4 years, while mean duration of stay has decreased from 11 to 7 days.
Diagnostic evaluation may be difficult in some forms of the disease or in patients whose neurosensory deficits make neuropsychological investigation practically impossible, but in these units patients can benefit from two or three days observation by specialist staff. The main complications leading to admission are psychiatric complications (delirium, hallucinations, depression, severe anxiety, agitation, aggressiveness, sleep disorders) or behavioural problems (fugues, wandering, shouting, refusal...), feeding problems (refusal to eat, weight loss, anorexia), gait abnormalities, domestic accidents, falls and fractures.
As these patients are elderly, many other disorders may be associated with Alzheimer disease : cancer, anaemia or infection. Appropriate management must take the patient’s dementia into account. Requests for admission should generally not be dealt with in emergency, as most often once the crisis is over and the situation has been carefully explained to the family, it is better that the patient should return home, with increased support. The necessary time can then be taken, calmly and serenely, to look for a suitable nursing home where the family can visit the patient and the family physician can still follow him or her as desired. The patient can be rapidly readmitted if necessary and the acute care unit is open 24 hours a day ; this is usually sufficient to reassure the family.
In a comparative study sponsored by the European Commission of 57 patients with severe dementia hospitalised in the Alzheimer Acute Care Unit or in conventional geriatric units, we demonstrated that in an acute care unit behavioural problems can be reduced without the need for restraint, which is not the case in non-specialised units. Moreover, follow-up of our patients at six months showed persistent improvement in behavioural problems, no doubt due to better education of the family and home carers and more rational administration of treatment.