Prevalence and characteristics of neuropsychiatric symptoms, quality of life and psychotropics in people with acquired brain injury in long-term care.

Roy Kohnen,Raymond Koopmans,Odile Smals,Debby Gerritsen,Jan Lavrijsen

doi:10.1111/jan.14156

Abstract

AimEstablishing the prevalence of neuropsychiatric symptoms (NPS), quality of life and psychotropic drug use in people aged ≤65 years with acquired brain injury in nursing homes.DesignCross‐sectional, observational study among patients aged 18–≤65 years with acquired brain injury admitted to special care units in Dutch nursing homes.MethodsAccording to the Committee on Research Involving Human Subjects in January 2017 this study did not require ethics approval. Nursing homes will be recruited through the national acquired brain injury expertise network for patients with severe brain injury, the regional brain injury teams and by searching the internet. Patient characteristics will be collected through digital questionnaires. Neuropsychiatric symptoms will be assessed with the NeuroPsychiatric Inventory‐Nursing Home version, the Cohen–Mansfield Agitation Inventory and the St. Andrews Sexual Behaviour Assessment; cognition with the Mini‐Mental State Examination, quality of life with the Quality of Life after Brain Injury Overall Scale and activities of daily living with the Disability Rating Scale. Medication will be retrieved from the electronic prescription system. Data collection commenced in 2017 and will be followed by data analysis in 2019. Reporting will be completed in 2020.DiscussionLittle is known about NPS among patients with acquired brain injury in nursing homes. In patients up to the age of 65 years, only six studies were found on prevalence rates of NPS.ImpactPatients with severe acquired brain injury experience lifelong consequences, that have a high impact on them and their environment. Although there is increasing attention for the survival of this vulnerable group of patients, it is also important to enlarge awareness on long‐term consequences, specifically the NPS, quality of life and psychotropic drug use in acquired brain injury. Insight into the magnitude of these issues is necessary to achieve appropriate care for these patients.

Highlights

Neuropsychiatric symptoms put a high burden on patients and their environment such as family and nursing staff (Alderman, 2007; Johnson & Balleny, 1996)
neuropsychiatric symptoms (NPS) such as aggressive behaviour and inappropriate sexual behaviour (ISB) amongst patients with Acquired brain injury (ABI) are problematic for patients, families and professionals (Alderman, Knight, & Henman, 2002; Knight et al, 2008)
ISBs were present in a minority of patients with severe traumatic brain injury (TBI) (8.9% of N = 507) and a mean age of 32.7 years at injury in a community‐based rehabilita‐ tion cohort, they pose a complex clinical challenge (Simpson, Sabaz, & Daher, 2013)

Summary

Introduction

Neuropsychiatric symptoms put a high burden on patients and their environment such as family and nursing staff (Alderman, 2007; Johnson & Balleny, 1996). NPS such as aggressive behaviour and inappropriate sexual behaviour (ISB) amongst patients with ABI are problematic for patients, families and professionals (Alderman, Knight, & Henman, 2002; Knight et al, 2008). ISBs were present in a minority of patients with severe TBI (8.9% of N = 507) and a mean age of 32.7 years at injury in a community‐based rehabilita‐ tion cohort, they pose a complex clinical challenge (Simpson, Sabaz, & Daher, 2013). One study conducted in a specialized postacute treatment cen‐ tre for adult inpatients with ABI, which is part of a large general psychiatric hospital, (N = 57; mean age 49.2 years) found significant associations of aggression with gender, legal status on admission (voluntarily or involuntarily), duration of admission and hypoxia as a cause of ABI (Visscher, van Meijel, Stolker, Wiersma, & Nijman, 2011). Of the nine patients with hypoxia as aetiology, seven were aggressive

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