PREVALENCE AND CORRELATES OF PSEUDOBULBAR AFFECT (PBA) SYMPTOMS IN NURSING HOME RESIDENTS

Abstract

Background: Reduction of antipsychotic medication use in nursing homes is a government mandate in the United States (U.S.). Recent U.S. studies have reported a high prevalence of potentially inappropriate prescribing of antipsychotics among patients with dementia in nursing homes. In addition to therapy for psychosis, these medicines are also used for management of disruptive behaviors such as inappropriate crying, laughing, and anger. These symptoms may be manifestations of pseudobulbar affect (PBA). Prevalence of PBA among nursing home residents with dementia is unknown; among noninstitutionalized adults with dementia, published prevalence of PBA symptoms ranges from 10% to 39%. Methods: This patient screen/chart review included all residents (N1⁄4811) of a convenience sample of 9 nursing homes in Michigan. Data were collected in the subset of 418 residents who met inclusion criteria (having a neurological diagnosis) and excluded those with a diagnosis of psychosis. Clinical assessments included the Center for Neurologic StudyâV’Lability Scale (CNS-LS; a research tool for assessment of PBA symptoms), a PBA diagnostic checklist, and extraction of predetermined items from each resident’s most recent Minimum Data Set (3.0) assessment. The presence of PBA symptoms was defined as a CNS-LS score 13. Results: Of eligible residents, 74 met the CNS-LS threshold for PBA symptoms (17.7%), yielding a possible PBA symptom prevalence of 9.1% of all nursing home residents. Those with PBA symptoms were of similar age to those without but were more likely to be white and female. Those with CNS-LS 13 had higher rates of depression and anxiety as well as higher likelihood of receiving psychotropic medications. The 9 Michigan nursing homes studied were similar to the national average in size and level of regulatory compliance; the studied nursing homes were more likely to be for-profit chain facilities and had larger proportions of Medicaid recipients and residents with dementia than the national averages. Conclusions: In this study, almost 1 in 10 nursing home residents, and 17.7% of those with neurological disorders, displayed symptoms of PBA, a disorder for which antipsychotic medications are not FDA approved. Greater awareness, diagnosis, and treatment of PBA may help reduce indiscriminate use of antipsychotics for nursing home residents with dementia.