Abstract
ObjectivesEstablishing the prevalence and determinants of neuropsychiatric symptoms (NPS) in patients with acquired brain injury (ABI) in nursing homes. DesignCross-sectional, observational study. Setting and ParticipantsPatients 18-65 years old with ABI in special care units in Dutch nursing homes. MethodsNursing homes were recruited through the national expertise network for patients with severe ABI, regional brain injury teams, and by searching the Internet. Patient characteristics were collected through digital questionnaires. NPS were assessed with the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) and the Cohen-Mansfield Agitation Inventory (CMAI), cognition with the Mini-Mental State Examination, and activities of daily living with the Disability Rating Scale. Psychotropic drug use (PDU) was retrieved from the electronic prescription system. Individual NPS were clustered. Associations between determinants and NPS were examined using multilevel multivariate linear regression models. ResultsIn a population of 118 patients from 12 nursing homes, 73.7% had 1 or more clinically relevant NPS and 81.3% 1 or more agitated behaviors. The most common NPS were agitation, in particular aberrant motor behavior (24.6%), repetitious sentences/questions (35.5%), and constant requests for attention (34.6%), verbal (33.6%) and physical (50.5%) aggression, and irritability (28.0%). Male patients were more likely to display hyperactivity. Being married was associated with less verbally agitated behavior and pain was associated with a higher CMAI total score. PDU increased the likelihood of a higher NPI-NH total score. Conclusions and ImplicationsNPS are common in patients with ABI ≤65 years of age residing in nursing homes. This is a first step to fill in the knowledge gap concerning NPS in this population. An increasing number of patients with severe ABI may survive the acute phase and will reside many years in nursing homes. It is important to shed more light on these NPS, with regard to course, magnitude, and severity, to ultimately develop appropriate care for this vulnerable group of patients.
Highlights
neuropsychiatric symptoms (NPS) are common in patients with acquired brain injury (ABI) 65 years of age residing in nursing homes
We studied the association between the primary outcomes (1) the Cohen-Mansfield Agitation Inventory (CMAI) and Neuropsychiatric Inventory-Nursing Home version (NPI-NH) total scores; (2) the cluster scores hyperactivity, mood/apathy, and psychosis from the NPI-NH; and (3) physically nonaggressive behavior, physically aggressive behavior, and verbally agitated behavior from the CMAI as dependent variables with the patient characteristics gender, age, marital status, level of education, cause of ABI, age of onset ABI, duration of ABI, duration of nursing home admission, psychiatric history, pain, constipation, spasms, disability, cognition, and the presence of Psychotropic drug use (PDU) as independent variables
Data on the CMAI and Mini-Mental State Examination (MMSE) was missing in 11 patients and Disability Rating Scale (DRS) in 8 patients
Summary
Establishing the prevalence and determinants of neuropsychiatric symptoms (NPS) in patients with acquired brain injury (ABI) in nursing homes. Results: In a population of 118 patients from 12 nursing homes, 73.7% had 1 or more clinically relevant NPS and 81.3% 1 or more agitated behaviors. Being married was associated with less verbally agitated behavior and pain was associated with a higher CMAI total score. Conclusions and Implications: NPS are common in patients with ABI 65 years of age residing in nursing homes. This is a first step to fill in the knowledge gap concerning NPS in this population. An increasing number of patients with severe ABI may survive the acute phase and will reside many years in nursing homes. It is important to shed more light on these NPS, with regard to course, magnitude, and severity, to develop appropriate care for this vulnerable group of patients
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