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Characteristics and health conditions of a group of nursing home patients with mental–physical multimorbidity – the MAPPING study

Published online by Cambridge University Press:  06 March 2017

Anne M.A. van den Brink ,
Debby L. Gerritsen ,
Miranda M.H. de Valk ,
Richard C. Oude Voshaar  and
Raymond T.C.M. Koopmans
Anne M.A. van den Brink*
Affiliation:
De Waalboog, ‘Joachim en Anna’, Centre for Specialized Geriatric Care, Nijmegen, the Netherlands Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands
Debby L. Gerritsen
Affiliation:
De Waalboog, ‘Joachim en Anna’, Centre for Specialized Geriatric Care, Nijmegen, the Netherlands Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands
Miranda M.H. de Valk
Affiliation:
De Waalboog, ‘Joachim en Anna’, Centre for Specialized Geriatric Care, Nijmegen, the Netherlands
Richard C. Oude Voshaar
Affiliation:
University Medical Center Groningen, University of Groningen, University Center for Psychiatry and Interdisciplinary Center for Psychopathology of Emotion regulation, Groningen, the Netherlands
Raymond T.C.M. Koopmans
Affiliation:
De Waalboog, ‘Joachim en Anna’, Centre for Specialized Geriatric Care, Nijmegen, the Netherlands Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands
*
Correspondence should be addressed to: Anne M.A. van den Brink, Radboudumc, Afdeling ELG, huispostnummer 117, t.a.v. Anne van den Brink, Postbus 9101, 6500 HB Nijmegen, the Netherlands. Phone: +316-1-0952406; Fax: +312-4-3635120. Email: [email protected].
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Abstract

Background:

Long-term care facilities have partly taken over the traditional asylum function of psychiatric hospitals and house an increasing group of patients with mental–physical multimorbidity (MPM). Little is known about the characteristics, behavior, and care dependency of these patients. This paper aims to describe these aspects.

Methods:

Explorative, descriptive study among patients with MPM without dementia (n = 142), living in 17 geronto-psychiatric nursing home (NH) units across the Netherlands, stratified by those referred from mental healthcare services (MHS) and other healthcare services (OHS). Data collection consisted of chart review, semi-structured interviews, (brief) neuropsychological testing, and self-report questionnaires. Patients referred from MHS (n = 58) and from OHS (n = 84) were compared by descriptive statistics.

Results:

Despite exclusion of patients with dementia, the majority of participants had cognitive impairment. Prevalence and severity of frontal impairment were high, as well as the number of patients with clinically relevant neuropsychiatric symptoms. MHS patients were younger, had more chronic psychiatric disorders, and more often used antipsychotics. Neuropsychiatric symptoms, domains of care dependency, physical conditions and concomitant medication use differed not significantly between the subgroups.

Conclusions:

Both groups of patients with MPM showed heterogeneity in various aspects but differed not significantly regarding the consequences of their multimorbidity. In a variety of characteristics, this group seems to be different from other NH patient groups, which requires extra knowledge and skills of the staff. To uncover which knowledge and skills are necessary, the next step should be to investigate the specific care needs of NH patients with MPM without dementia.

Keywords

mental–physical multimorbiditygeriatric psychiatrylong-term carenursing home
Type
Research Article
Information
International Psychogeriatrics , Volume 29 , Issue 6 , June 2017 , pp. 1037 - 1047
Copyright
Copyright © International Psychogeriatric Association 2017 

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References

Bartels, S. J., Miles, K. M., Dums, A. R. and Levine, K. J. (2003). Are nursing homes appropriate for older adults with severe mental illness? Conflicting consumer and clinician views and implications for the Olmstead decision. Journal of the American Geriatrics Society, 51, 1571–1579.CrossRefGoogle ScholarPubMed
Boban, M., Malojcic, B., Mimica, N., Vukovic, S. and Zrilic, I. (2012). The frontal assessment battery in the differential diagnosis of dementia. Journal of Geriatric Psychiatry and Neurology, 25, 201–207. doi: 10.1177/0891988712464821.Google Scholar
Cohen-Mansfield, J. and Billig, N. (1986). Agitated behaviors in the elderly. I. A conceptual review. Journal of the American Geriatrics Society, 34, 711–721.Google Scholar
Collet, J., de Vugt, M. E., Verhey, F. R., Engelen, N. J. and Schols, J. M. (2016). Characteristics of double care demanding patients in a mental health care setting and a nursing home setting: results from the SpeCIMeN study. Aging & Mental Health, 1–7. DOI: 10.1080/13607863.2016.1202891 Google Scholar
Cravello, L., Palmer, K., de Girolamo, G., Caltagirone, C. and Spalletta, G. (2011). Neuropsychiatric symptoms and syndromes in institutionalized elderly people without dementia. International Psychogeriatrics, 23, 425–434. doi: S1041610210001304 [pii] 10.1017/S1041610210001304.Google Scholar
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.CrossRefGoogle ScholarPubMed
Dijkstra, A., Buist, A. H., Dassen, T. and van den Heuvel, W. J. A. (2012). Het meten van zorgafhankelijkheid met de ZorgAfhankelijkheidsSchaal (ZAS): een handleiding (The Measurement of Care Dependency With the Care Dependency Scale (CDS): A Manual); Tweede Herziene Druk. Groningen: Research Institute SHARE, UMCG/Rijksuniversiteit.Google Scholar
Dijkstra, A., Tiesinga, L. J., Goossen, W. T. and Dassen, T. W. (2002). Further psychometric testing of the Dutch care dependency scale on two different patient groups. International Journal of Nursing Practice, 8, 305–314.CrossRefGoogle ScholarPubMed
Dubois, B., Slachevsky, A., Litvan, I. and Pillon, B. (2000). The FAB: a Frontal Assessment Battery at bedside. Neurology, 55, 1621–1626.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Fullerton, C. A., McGuire, T. G., Feng, Z., Mor, V. and Grabowski, D. C. (2009). Trends in mental health admissions to nursing homes, 1999-2005. Psychiatric Services, 60, 965–971.CrossRefGoogle ScholarPubMed
Iverson, G. L., Hopp, G. A., DeWolfe, K. and Solomons, K. (2002). Measuring change in psychiatric symptoms using the Neuropsychiatric Inventory: Nursing Home Version. International Journal of Geriatric Psychiatry, 17, 438–443.Google Scholar
Jongenelis, K., Pot, A. M., Eisses, A. M., Beekman, A. T., Kluiter, H. and Ribbe, M. W. (2004). Prevalence and risk indicators of depression in elderly nursing home patients: the AGED study. Journal of Affective Disorders, 83, 135–142.Google Scholar
Koopmans, R. T., Lavrijsen, J. C. and Hoek, F. (2013). Concrete steps toward academic medicine in long term care. Journal of American Medical Directors Association, 14, 781–783. doi: 10.1016/j.jamda.2013.08.004.Google Scholar
Koopmans, R. T., Lavrijsen, J. C., Hoek, J. F., Went, P. B. and Schols, J. M. (2010). Dutch elderly care physician: a new generation of nursing home physician specialists. Journal of the American Geriatrics Society, 58, 1807–1809. doi: 10.1111/j.1532-5415.2010.03043.x.Google Scholar
Lange, R. T., Hopp, G. A. and Kang, N. (2004). Psychometric properties and factor structure of the Neuropsychiatric Inventory Nursing Home Version in an elderly neuropsychiatric population. International Journal of Geriatric Psychiatry, 19, 440–448.CrossRefGoogle Scholar
Leontjevas, R. et al. (2013). More insight into the concept of apathy: a multidisciplinary depression management program has different effects on depressive symptoms and apathy in nursing homes. International Psychogeriatrics, 25, 1941–1952. doi: 10.1017/S1041610213001440.Google Scholar
Miller, R. J., Snowdon, J. and Vaughan, R. (1995). The use of the Cohen-Mansfield Agitation Inventory in the assessment of behavioral disorders in nursing homes. Journal of the American Geriatrics Society, 43, 546–549.Google Scholar
Molloy, D. W., Alemayehu, E. and Roberts, R. (1991). Reliability of a Standardized Mini-Mental State Examination compared with the traditional Mini-Mental State Examination. The American Journal of Psychiatry, 148, 102–105.Google Scholar
Nienhuis, F. J., van de Willige, G., Rijnders, C. A., de Jonge, P. and Wiersma, D. (2010). Validity of a short clinical interview for psychiatric diagnosis: the mini-SCAN. The British Journal of Psychiatry, 196, 64–68. doi: 196/1/64 [pii] 10.1192/bjp.bp.109.066563.Google Scholar
Novella, E. J. (2010). Mental health care in the aftermath of deinstitutionalization: a retrospective and prospective view. Health Care Analysis, 18, 222–238. doi: 10.1007/s10728-009-0138-8.CrossRefGoogle ScholarPubMed
Schaller, F. et al. (2012). Mild to moderate cognitive impairment is a major risk factor for mortality and nursing home admission in the first year after hip fracture. Bone, 51, 347–352. doi: 10.1016/j.bone.2012.06.004.Google Scholar
Seitz, D., Purandare, N. and Conn, D. (2010). Prevalence of psychiatric disorders among older adults in long-term care homes: a systematic review. International Psychogeriatrics, 22, 1025–1039.CrossRefGoogle ScholarPubMed
van Almenkerk, S., Depla, M. F., Smalbrugge, M., Eefsting, J. A. and Hertogh, C. M. (2012). Institutionalized stroke patients: status of functioning of an under researched population. Journal of the American Medical Directors Association, 13, 634–639. doi: 10.1016/j.jamda.2012.05.008.Google Scholar
van den Brink, A. M., Gerritsen, D. L., Oude Voshaar, R. C. and Koopmans, R. T. (2014). Patients with mental-physical multimorbidity: do not let them fall by the wayside. International Psychogeriatrics, 26, 1585–1589. doi: 10.1017/S104161021400163X.Google Scholar
van den Brink, A. M., Gerritsen, D. L., Voshaar, R. C. and Koopmans, R. T. (2013). Residents with mental-physical multimorbidity living in long-term care facilities: prevalence and characteristics. A systematic review. International Psychogeriatrics, 25, 531–548. doi: 10.1017/S1041610212002025.Google Scholar
Van Loo, E. H., Wiebrands, C. and Van Laar, T. (2007). De 'Frontal Assessment Battery'(FAB) voor screening op frontaalkwabpathologie bij neurodegeneratieve ziekten. Tijdschrift voor Neurologie en Neurochirurgie, 108, 115–120.Google Scholar
Wetzels, R. B., Zuidema, S. U., de Jonghe, J. F., Verhey, F. R. and Koopmans, R. T. (2010). Course of neuropsychiatric symptoms in residents with dementia in nursing homes over 2-year period. The American Journal of Geriatric Psychiatry, 18, 1054–1065.Google Scholar
Wing, J. K. et al. (1990). SCAN. Schedules for Clinical Assessment in Neuropsychiatry. Archives of General Psychiatry, 47, 589–593.Google Scholar
Wood, S. et al. (2000). The use of the neuropsychiatric inventory in nursing home residents. Characterization and measurement. The American Journal of Geriatric Psychiatry, 8, 75–83.CrossRefGoogle ScholarPubMed
Woodford, H. J. and George, J. (2007). Cognitive assessment in the elderly: a review of clinical methods. QJM, 100, 469–484. doi: 10.1093/qjmed/hcm051.CrossRefGoogle ScholarPubMed
Zuidema, S. U., Derksen, E., Verhey, F. R. and Koopmans, R. T. (2007). Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. International Journal of Geriatric Psychiatry, 22, 632–638. doi: 10.1002/gps.1722.Google Scholar