Abstract
BackgroundEarlier studies of nursing home patients show a high prevalence of dementia, neuropsychiatric symptoms (NPS), pain, and dependency in activities of daily living. The REDIC-NH cohort was set up to study the disease course and the resources used in patients with dementia in Norway. The aim of this paper was to describe the methods and the data collection, and to present selected data about patients at admission to a nursing home.MethodsWe included 696 patients at admission to a nursing home and followed them with biannual assessments until death. Baseline data were collected between March 2012 and November 2014. In October 2016, patients had either completed an 18-month follow-up (n = 349), passed 18 months without assessments (n = 22), or left the study (n = 324). Data on demographics, cognition, NPS, activities of daily living (ADL) functioning, physical health, medication, Quality of Life (QoL), resource use, and caregiver burden, in addition to DNA samples were collected.ResultsMean age of the participants at inclusion was 84.5 years (SD 7.5, range 50 – 105), 63.9% were women. According to data collected in the study, 83.8% had dementia, but only 55.9% of them had a diagnosis of dementia registered in their records. The most frequent dementia diagnosis was Alzheimer’s disease, which was present in 71% of those with dementia. Patients with dementia more often experienced delusions, hallucinations, agitation, anxiety, disinhibition, irritability, and aberrant motor behaviour compared to patients without dementia. Depression and anxiety were the most common NPS symptoms.ConclusionsDementia and NPS were highly prevalent among persons admitted to nursing homes. Only 55.9% of the patients with dementia had a diagnosis of dementia registered in their records.
Highlights
Earlier studies of nursing home patients show a high prevalence of dementia, neuropsychiatric symptoms (NPS), pain, and dependency in activities of daily living
Sedatives were more often prescribed to the patients without dementia than to patients with dementia (p = 0.004), Table 2 Demographic and clinical data of the patients at admission to nursing homes (NH)
The main finding of this study is the high prevalence of dementia (83.8%) at admission to the NH, comparable to figures in cross-sectional studies of Norwegian NHs showing a prevalence of 81.5% [3] and 78.5% [6], but different from a descriptive study from Belgium [7] in which 48% had dementia at admission
Summary
Earlier studies of nursing home patients show a high prevalence of dementia, neuropsychiatric symptoms (NPS), pain, and dependency in activities of daily living. NPS include psychiatric symptoms such as delusions, hallucinations, depression, anxiety, and euphoria, and behavioural symptoms such as agitation, aggression, apathy, and disinhibition. Agitation (36%), apathy (36%), aggression (32%) and depression (28%) are the most prevalent symptoms [4]. Agitation and apathy are the most persistent NPS over time [4], and the prevalence of individual NPS changes with the progression of the dementia [2, 5,6,7]. Data from randomised controlled trials and large registrybased studies indicate that the use of antipsychotic drugs is associated with increased mortality and an increased risk of cerebrovascular adverse events [11]. The cost of dementia in Norway is estimated to be €3.02 billion a year [17]
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