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Abstract

Objectives
To determine the prevalence and determinants of neuropsychiatric symptoms (NPS) in patients with acquired brain injury (ABI) in nursing homes.

Design
Cross-sectional, observational study.

Setting and participants
Patients aged 18-65 years with ABI in special care units in Dutch nursing homes.

Methods
Nursing 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 by means of 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. The use of psychotropic drugs (PDU) was retrieved from the electronic prescribing system. Individual NPS were clustered. Associations between determinants and NPS were investigated using multilevel multivariate linear regression models.

Results
In a population of 118 patients from 12 nursing homes, 73.7% had 1 or more clinically relevant NPS and 81.3% had 1 or more agitated behaviors. The most common NPS were agitation, especially abnormal motor behavior (24.6%), repetitive 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 show hyperactivity. Being married was associated with less verbally agitated behavior, and pain was associated with a higher CMAI total score. PDU increased the chance of a higher NPI-NH total score.

Conclusions and implications
NPS is common in patients with ABI aged 65 who live in nursing homes. This is a first step to fill the knowledge gap around NPD in this population. An increasing number of patients with severe ABI can survive the acute phase and will stay in nursing homes for many years. It is important to shed more light on this NPS, with regard to course, extent and severity, in order to ultimately develop appropriate care for this vulnerable group of patients.

Keywords
Acquired brain injury, neuropsychiatric symptoms, prevalence, determinants, nursing home, long-term care