Abstract
AimThe aim of this study was to describe the prevalence and persistence of clinically significant neuropsychiatric symptoms (NPS) in nursing home residents with dementia, and to study the association between severity of dementia and specific neuropsychiatric sub-syndromes over time.MethodsIn total, 583 residents with dementia were included at admission to a nursing home and followed with biannual assessments until death, or to 30-month follow-up. At the end of the 30-month follow-up, 305 participants had died and 57 had left the study for other reasons, leaving 221 residents in the study. We collected data on demographics, cognition, severity of dementia, NPS, personal activities of daily living (P-ADL), physical health, medication and type of nursing home unit. NPS was assessed using the Neuropsychiatric Inventory (NPI), the Nursing Home version.ResultsThe prevalence and persistence at two consecutive time-points of clinically significant NPS was high during the study period. The mean NPI agitation sub-syndrome score increased during the study period, while the NPI affective and psychosis sub-syndrome scores remained unchanged. More severe dementia was associated with higher NPI agitation, psychosis and affective sub-syndrome scores. The association remained unchanged over time for agitation and psychosis. For the NPI affective sub-syndrome, the association was stronger at the beginning, and declined towards the end of the study period.ConclusionThe findings of high prevalence and persistence at two consecutive time points of clinically significant NPS over time, and the associations between severity of dementia and NPI sub-syndromes shed light on the burden and care needs of nursing home residents with dementia after admission to nursing home care. This information is of interest to health care planners and providers to enable them to increase the quality of care for nursing home residents.
Highlights
Neuropsychiatric symptoms (NPS) normally occur during the natural course of dementia [1]
The mean Neuropsychiatric Inventory (NPI) agitation sub-syndrome score increased during the study period, while the mean NPI affective and psychosis sub-syndrome scores remained unchanged
More severe dementia was associated with a higher NPI agitation and psychosis sub-syndrome score, an association that remained unchanged over time
Summary
Neuropsychiatric symptoms (NPS) normally occur during the natural course of dementia [1]. NPS may either be subjectively experienced by the individual with dementia or observed by their of kin or caregivers. These symptoms may contribute to a feeling of distress and discomfort, and are associated with a poorer quality of life [2,3,4,5]. NPS tend to increase depression [10] and reduce quality of life [11] for of kin. Higher levels of NPS are associated with a greater burden on informal caregivers [10, 12] and an increase in the cost of care [13]. NPS are a cause of institutionalization for people with dementia [9, 14] and present a significant challenge in dementia care [15]
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