Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-22T18:17:44.610Z Has data issue: false hasContentIssue false

Residents with mental–physical multimorbidity living in long-term care facilities: prevalence and characteristics. A systematic review

Published online by Cambridge University Press:  04 December 2012

Anne M. A. van den Brink*
Affiliation:
De Waalboog, Specialized Geriatric Care Centre “Joachim en Anna”, Nijmegen, the Netherlands Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen, Medical Centre, Nijmegen, the Netherlands
Debby L. Gerritsen
Affiliation:
Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen, Medical Centre, Nijmegen, the Netherlands
Richard C. Oude Voshaar
Affiliation:
University Center for Psychiatry and Interdisciplinary Center for Psychopathology of Emotion regulation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
Raymond T. C. M. Koopmans
Affiliation:
De Waalboog, Specialized Geriatric Care Centre “Joachim en Anna”, Nijmegen, the Netherlands Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen, Medical Centre, Nijmegen, the Netherlands
*
Correspondence should be addressed to: Anne van den Brink, Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen, Medical Centre, P.O. Box 9101, code 117 ELG, 6500 HB Nijmegen, the Netherlands. Phone: +31 24 361 7084; Fax: +31 24 354 1862. Email: [email protected].
Get access

Abstract

Background: Aging societies will be confronted with increased numbers of long-term care (LTC) residents with multimorbidity of physical and mental disorders other than dementia. Knowledge about the prevalence rates, medical and psychosocial characteristics, and care needs of this particular group of residents is mandatory for providing high-quality and evidence-based care. The purpose of this paper was to review the literature regarding these features.

Methods: A systematic literature search was conducted in PubMed, EMBASE, PsycINFO, and CINAHL from January 1, 1988 to August 16, 2011. Two reviewers independently assessed eligibility of studies on pre-established inclusion criteria as well as methodological quality using standardized checklists.

Results: Seventeen articles were included. Only one small study describes multimorbidity of a wide range of chronic psychiatric and somatic conditions in LTC residents and suggests that physical–mental multimorbidity is rather rule than exception. All other studies show prevalence rates of comorbid physical and mental illnesses (range, 0.5%–64.7%), roughly in line with reported prevalence rates among community-dwelling older people. LTC residents with mental–physical multimorbidity were younger than other LTC residents and had more cognitive impairment, no dementia, and problem behaviors. Care needs of these residents were not described.

Conclusions: Although exact figures are lacking, mental–physical multimorbidity is common in LTC residents. Given the specific characteristics of the pertaining residents, more knowledge of their specific care needs is essential. The first step now should be to perform research on symptoms and behavior, which seem more informative than diagnostic labels as well as care needs of LTC residents with mental–physical multimorbidity.

Type
Review Article
Copyright
Copyright © International Psychogeriatric Association 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akner, G. (2009). Analysis of multimorbidity in individual elderly nursing home residents. Development of a multimorbidity matrix. Archives of Gerontology and Geriatrics, 49, 413419.CrossRefGoogle ScholarPubMed
Andrade, L. H., Bensenor, I. M., Viana, M. C., Andreoni, S. and Wang, Y. P. (2010). Clustering of psychiatric and somatic illnesses in the general population: multimorbidity and socioeconomic correlates. Brazilian Journal of Medical and Biological Research, 43, 483491.CrossRefGoogle ScholarPubMed
Angelelli, P.et al. (2004). Development of neuropsychiatric symptoms in poststroke patients: a cross-sectional study. Acta Psychiatrica Scandinavica, 110, 5563.CrossRefGoogle ScholarPubMed
Aschbrenner, K., Grabowski, D. C., Cai, S., Bartels, S. J. and Mor, V. (2011). Nursing home admissions and long-stay conversions among persons with and without serious mental illness. Journal of Aging & Social Policy, 23, 286304. doi: 10.1080/08959420.2011.579511.CrossRefGoogle ScholarPubMed
Bagchi, A. D., Verdier, J. M. and Simon, S. E. (2009). How many nursing home residents live with a mental illness? Psychiatric Services, 60, 958964. doi: 10.1176/appi.ps.60.7.958.CrossRefGoogle ScholarPubMed
Barca, M. L., Selbaek, G., Laks, J. and Engedal, K. (2009). Factors associated with depression in Norwegian nursing homes. International Journal of Geriatric Psychiatry, 24, 417425.CrossRefGoogle ScholarPubMed
Bartels, S. J., Levine, K. J. and Shea, D. (1999). Community-based long-term care for older persons with severe and persistent mental illness in an era of managed care. Psychiatric Services, 50, 11891197.CrossRefGoogle Scholar
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, 15711579.CrossRefGoogle ScholarPubMed
Bartels, S. J., Moak, G. S. and Dums, A. R. (2002). Models of mental health services in nursing homes: a review of the literature. Psychiatric Services, 53, 13901396.CrossRefGoogle ScholarPubMed
Bartels, S. J., Mueser, K. T. and Miles, K. M. (1997). A comparative study of elderly patients with schizophrenia and bipolar disorder in nursing homes and the community. Schizophrenia Research, 27, 181190. doi: 10.1016/S0920-9964(97)00080-7.CrossRefGoogle ScholarPubMed
Bellows, N. M. and Halpin, H. A. (2008). Impact of Medicaid reimbursement on mental health quality indicators. Health Services Research, 43, 582597. doi: 10.1111/j.1475-6773.2007.00769.x.CrossRefGoogle ScholarPubMed
Boyle, M. H. (1998). Guidelines for evaluating prevalence studies. Evidence-Based Mental Health, 1, 3739.CrossRefGoogle Scholar
Buchanan, R. J., Wang, S. and Huang, C. (2002). Analyses of nursing home residents with human immunodeficiency virus and depression using the minimum data set. AIDS Patient Care and STDs, 16, 441455. doi: 10.1089/108729102760330281.CrossRefGoogle ScholarPubMed
Buchanan, R. J., Wang, S., Tai-Seale, M. and Ju, H. (2003). Analyses of nursing home residents with multiple sclerosis and depression using the Minimum Data Set. Multiple Sclerosis, 9, 171188.CrossRefGoogle ScholarPubMed
Cuijpers, P. and Van Lammeren, P. (1999). Depressive symptoms in chronically ill elderly people in residential homes. Aging & Mental Health, 3, 221226.CrossRefGoogle Scholar
de Girolamo, G. and Bassi, M. (2004). Residential facilities as the new scenario of long-term psychiatric care. Current Opinion in Psychiatry, 17, 275281. doi: 10.1097/01.yco.0000133830.04049.7b.CrossRefGoogle Scholar
de Girolamo, G.et al. (2005). The severely mentally ill in residential facilities: a national survey in Italy. Psychological Medicine, 35, 421431.CrossRefGoogle ScholarPubMed
de Heer-Wunderink, C., Caro-Nienhuis, A. D., Sytema, S. and Wiersma, D. (2008). Residential care: Dutch and Italian residents of residential care facilities compared. Epidemiologica e Psichiatria Sociale, 17, 162165.CrossRefGoogle ScholarPubMed
Fortin, M., Lapointe, L., Hudon, C. and Vanasse, A. (2005). Multimorbidity is common to family practice: is it commonly researched? Canadian Family Physician, 51, 244245.Google ScholarPubMed
Frankenburg, F. R. and Zanarini, M. C. (2004). The association between borderline personality disorder and chronic medical illnesses, poor health-related lifestyle choices, and costly forms of health care utilization. Journal of Clinical Psychiatry, 65, 16601665.CrossRefGoogle ScholarPubMed
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, 965971.CrossRefGoogle ScholarPubMed
Gijsen, R., Hoeymans, N., Schellevis, F. G., Ruwaard, D., Satariano, W. A. and van den Bos, G. A. (2001). Causes and consequences of comorbidity: a review. Journal of Clinical Epidemiology, 54, 661674.CrossRefGoogle ScholarPubMed
Grabowski, D. C., Aschbrenner, K. A., Rome, V. F. and Bartels, S. J. (2010). Quality of mental health care for nursing home residents: a literature review. Medical Care Research and Review, 67, 627656. doi: 10.1177/1077558710362538.CrossRefGoogle ScholarPubMed
Haworth, J. E., Moniz-Cook, E., Clark, A. L., Wang, M., Waddington, R. and Cleland, J. G. (2005). Prevalence and predictors of anxiety and depression in a sample of chronic heart failure patients with left ventricular systolic dysfunction. European Journal of Heart Failure, 7, 803808.CrossRefGoogle Scholar
Iacovides, A. and Siamouli, M. (2008). Comorbid mental and somatic disorders: an epidemiological perspective. Current Opinion in Psychiatry, 21, 417421.CrossRefGoogle ScholarPubMed
Jang, Y., Bergman, E., Schonfeld, L. and Molinari, V. (2006). Depressive symptoms among older residents in assisted living facilities. The International Journal of Aging & Human Development, 63, 299315. doi: 10.2190/7TTA-DQWR-T429-C4N4.CrossRefGoogle ScholarPubMed
Jang, Y., Bergman, E., Schonfeld, L. and Molinari, V. (2007). The mediating role of health perceptions in the relation between physical and mental health: a study of older residents in assisted living facilities. Journal of Aging and Health, 19, 439452.CrossRefGoogle ScholarPubMed
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, 135142.CrossRefGoogle Scholar
Kinsella, K. and He, W. (2009). An aging world: 2008. International Population Reports (p. 204). Washington, DC: U.S. Census Bureau, National Institute on Aging.Google Scholar
Lemke, S. and Schaefer, J. A. (2010). VA nursing home residents with substance use disorders: mental health comorbidities, functioning, and problem behaviors. Aging & Mental Health, 14, 593602. doi: 10.1080/13607860903586169.CrossRefGoogle ScholarPubMed
Li, Y. (2010). Provision of mental health services in U.S. nursing homes, 1995–2004. Psychiatric Services, 61, 349355.CrossRefGoogle ScholarPubMed
Lobo-Escolar, A., Saz, P., Marcos, G., Quintanilla, M. A., Campayo, A. and Lobo, A. (2008). Somatic and psychiatric comorbidity in the general elderly population: results from the ZARADEMP Project. Journal of Psychosomatic Research, 65, 347355.CrossRefGoogle ScholarPubMed
Marengoni, A., Winblad, B., Karp, A. and Fratiglioni, L. (2008). Prevalence of chronic diseases and multimorbidity among the elderly population in Sweden. American Journal of Public Health, 98, 11981200.CrossRefGoogle ScholarPubMed
Marengoni, A.et al. (2011). Aging with multimorbidity: a systematic review of the literature. Ageing Research Reviews, 10, 430439. doi: 10.1016/j.arr.2011.03.003.CrossRefGoogle ScholarPubMed
Mercer, S. W., Gunn, J., Bower, P., Wyke, S. and Guthrie, B. (2012). Managing patients with mental and physical multimorbidity. British Medical Journal, 345, e5559. doi: 10.1136/bmj.e5559.CrossRefGoogle ScholarPubMed
Mor, V., Angelelli, J., Jones, R., Roy, J., Moore, T. and Morris, J. (2003). Inter-rater reliability of nursing home quality indicators in the U.S. BMC Health Services Research, 3, 20. doi: 10.1186/1472-6963-3-20.CrossRefGoogle ScholarPubMed
Morris, J. N.et al. (1990). Designing the national resident assessment instrument for nursing homes. The Gerontologist, 30, 293307.CrossRefGoogle ScholarPubMed
Mukherjee, S., Decina, P., Bocola, V., Saraceni, F. and Scapicchio, P. L. (1996). Diabetes mellitus in schizophrenic patients. Comprehensive Psychiatry, 37, 6873.CrossRefGoogle ScholarPubMed
Novella, E. J. (2010). Mental health care in the aftermath of deinstitutionalization: a retrospective and prospective view. Health Care Analysis, 18, 222238. doi: 10.1007/s10728-009-0138-8.CrossRefGoogle ScholarPubMed
Nuyen, J.et al. (2006). Comorbidity was associated with neurologic and psychiatric diseases: a general practice-based controlled study. Journal of Clinical Epidemiology, 59, 12741284.CrossRefGoogle ScholarPubMed
Pitfield, C., Shahriyarmolki, K. and Livingston, G. (2011). A systematic review of stress in staff caring for people with dementia living in 24-hour care settings. International Psychogeriatrics, 23, 49. doi: 10.1017/S1041610210000542.CrossRefGoogle ScholarPubMed
Placentino, A.et al. (2009). Clinical characteristics in long-term care psychiatric patients: a descriptive study. The World Journal of Biological Psychiatry, 10, 5864.CrossRefGoogle ScholarPubMed
Reijnders, J. S., Ehrt, U., Weber, W. E., Aarsland, D. and Leentjens, A. F. (2008). A systematic review of prevalence studies of depression in Parkinson's disease. Movement Disorders, 23, 183189; quiz 313.CrossRefGoogle ScholarPubMed
Ribbe, M. W.et al. (1997). Nursing homes in 10 nations: a comparison between countries and settings. Age and Ageing, 26 (Suppl. 2), 312.CrossRefGoogle Scholar
Robinson, R. G. and Spalletta, G. (2010). Poststroke depression: a review. Canadian Journal of Psychiatry, 55, 341349.CrossRefGoogle ScholarPubMed
Sanderson, S., Tatt, I. D. and Higgins, J. P. (2007). Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography. International Journal of Epidemiology, 36, 666676. doi: 10.1093/ije/dym018.CrossRefGoogle ScholarPubMed
Schepers, J. P., Koopmans, R. T. and Bor, J. H. (2000). [Patients with Korsakoff's syndrome in a nursing home: characteristics and comorbidity]. Tijdschrift voor Gerontologie en Geriatrie, 31, 113118.Google Scholar
Schram, M. T.et al. (2008). Setting and registry characteristics affect the prevalence and nature of multimorbidity in the elderly. Journal of Clinical Epidemiology, 61, 11041112. doi: 10.1016/j.jclinepi.2007.11.021.CrossRefGoogle ScholarPubMed
Scott, K. M.et al. (2009). Mental-physical co-morbidity and its relationship with disability: results from the World Mental Health Surveys. Psychological Medicine, 39, 3343.CrossRefGoogle ScholarPubMed
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, 10251039.CrossRefGoogle ScholarPubMed
Singh, D. A. (2010a). Long-term care policy: past, present, and future. In Effective Management of Long-Term Care Facilities (pp. 2546). Burlington: Jones & Bartlett Learning.Google Scholar
Singh, D. A. (2010b). Overview of long-term care. In Effective Management of Long-Term Care Facilities (pp. 324). Burlington: Jones & Bartlett Learning.Google Scholar
Travis, S. S., Buchanan, R. J., Wang, S. and Kim, M. (2004). Analyses of nursing home residents with diabetes at admission. Journal of the American Medical Directors Association, 5, 320327.CrossRefGoogle ScholarPubMed
Trilling, J. S., Froom, J., Gomolin, I. H., Yeh, S. S., Grimson, R. C. and Nevin, S. (1998). Hypertension in nursing home patients. Journal of Human Hypertension, 12, 117121.CrossRefGoogle ScholarPubMed
van den Akker, M., Buntinx, F. and Knottnerus, J. A. (1996). Comorbidity or multimorbidity: what's in a name? A review of literature. The European Journal of General Practice, 2, 6570.CrossRefGoogle Scholar
van der Windt, D. A., Zeegers, M. P., Kemper, H. C., Assendelft, W. J. and Scholten, R. J. (2000). [Practice of systematic reviews. VI. Searching, selection and methodological evaluation of etiological research]. Nederlands Tijdschrift voor Geneeskunde, 144, 12101214.Google ScholarPubMed
Yohannes, A. M. (2005). Depression and COPD in older people: a review and discussion. British Journal of Community Nursing, 10, 4246.CrossRefGoogle ScholarPubMed
File 29.9 KB
Supplementary material: File

Van den Brink Supplementary Material

Appendix 2

Download Van den Brink Supplementary Material(File)
File 29 KB