For professionals

Abstract

Objectives
To determine the prevalence of inappropriate sexual behaviour, concomitant challenging behaviour and the determinants of inappropriate sexual behaviour in patients with acquired brain injury ≤65 years in Dutch nursing homes.

Design
Cross-sectional, observational research in special care units for acquired brain injury is spreading throughout the country.

Methods
Nursing homes were recruited through the national expertise network for patients with severe acquired brain injury, regional brain injury teams and by searching the internet. Patient characteristics were collected by means of digital questionnaires. Inappropriate sexual behavior was assessed with the St. Andrews Sexual Behavior Assessment, concomitant challenging behavior with the NeuroPsychiatric InventoryNursing Home Version and the Cohen-Mansfield Agitation Inventory, cognition with the Mini-Mental State Examination, and activities of daily living with the Disability Rating Scale. The use of psychotropic drugs was removed from the electronic prescription system. Associations between determinants and inappropriate sexual behavior were investigated using multilevel multivariate linear regression model analyses. Data collection began in June 2017 and ended in April 2019.

Results
Of the 118 patients included, 38.1% exhibited one or more inappropriate sexual behaviors. Verbal comments (30.1%) and non-contact behavior (24.8%) were the most common forms of inappropriate sexual behavior. Less serious behaviors were more common than more serious behaviors. The most common concurrent challenging behaviors were agitation, aggression, and hyperactivity. Physical aggression was associated with more inappropriate sexual behavior. Being married and pain were associated with less inappropriate sexual behavior.

Conclusion
Inappropriate sexual behavior is common in patients with acquired brain injury ≤65 years of age who live in nursing homes.

Impact
Inappropriate sexual behaviour can have consequences not only for the patients themselves, but also for the nursing staff. Insight into the extent, severity, course and associated challenging behaviour, sexuality and quality of life can guide the type of interventions and education that is needed. The ultimate goal is to develop appropriate care for this vulnerable group of patients, in particular psychosocial interventions and appropriate use of psychotropic drugs.

Keywords
acquired brain injury, Challenging behaviour, Sexual harassment, Long-term care, Nurses/midwives/nursing, Nursing home, Prevalence