Modifiable factors associated with neuropsychiatric symptoms in nursing homes: The impact of unmet needs and psychotropic drugs

Ana Rita Ferreira; Mário R Simões; Emília Moreira; Joana Guedes; Lia Fernandes

doi:10.1016/j.archger.2019.103919

Modifiable factors associated with neuropsychiatric symptoms in nursing homes: The impact of unmet needs and psychotropic drugs

Arch Gerontol Geriatr. 2020 Jan-Feb:86:103919. doi: 10.1016/j.archger.2019.103919. Epub 2019 Jul 29.

Authors

Ana Rita Ferreira¹, Mário R Simões², Emília Moreira³, Joana Guedes⁴, Lia Fernandes⁵

Affiliations

¹ CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal. Electronic address: up201309446@med.up.pt.
² Psychological Assessment Laboratory, CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal. Electronic address: simoesmr@fpce.uc.pt.
³ CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal. Electronic address: emiliamoreira@med.up.pt.
⁴ Higher Institute of Social Work of Porto, Porto, Portugal. Electronic address: joana.guedes@isssp.pt.
⁵ CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal; Clinical Neurosciences and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal; Clinic of Psychiatry and Mental Health, Centro Hospitalar Universitário de São João, Porto, Portugal. Electronic address: lfernandes@med.up.pt.

PMID: 31525557
DOI: 10.1016/j.archger.2019.103919

Abstract

Objective: This study aimed to explore neuropsychiatric symptoms' (NPS) risk factors in a sample of nursing home residents.

Methods: A cross-sectional study was conducted. Residents over 65 years were included, unless they had a known major psychiatric diagnosis. The Neuropsychiatric Inventory (NPI) was completed, and other measures included residents' sociodemographic characteristics, cognition, functional impairment, regular drugs and number of needs. To explore potential risk factors, a logistic regression was conducted with the presence of NPS (NPI-10 ≥ 1) as dependent variable. Additional exploratory analyses were conducted based on a sub-syndrome approach, and three multivariate models were repeated considering the psychotic, affective and behaviour syndromes as dependent variables.

Results: A total of 140 residents were included (age: 83.71 ± 7.29 years). More than half (50.4%) presented at least one NPS. NPI-10 showed significant correlations with cognition (r_s=-0.177, p = 0.042), functional impairment (r_s = 0.174, p = 0.043), unmet needs (r_s = 0.245, p = 0.004) and nervous system-acting drugs (r_s = 0.271, p = 0.002), particularly anxiolytics (r_s = 0.175, p = 0.047), antidepressants (r_s = 0.204, p = 0.019) and hypnotics/sedatives (U = 2434.5, p = 0.028). However, in the multivariate analysis only unmet needs (OR = 1.30; 95% CI: 1.008-1.670) and hypnotic/sedatives (OR = 4.66; 95% CI: 1.132-19.144) showed an independent association with the presence of NPS. Regarding the additional models, unmet needs and literacy, antidepressants and hypnotic/sedatives, and cognitive status, showed to contribute to explain the variability of psychotic, affective and behaviour syndromes, respectively.

Conclusions: Identifiable and modifiable factors, including unmet needs and prescribed psychotropic drugs, could have contributed to NPS in this sample, suggesting a role for targeted non-pharmacological and person-centred approaches directed to residents' unmet needs.

Keywords: Care needs; Cognition; Needs assessment; Neuropsychiatric symptoms; Nursing home; Psychotropic drugs.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Cross-Sectional Studies
Female
Humans
Logistic Models
Male
Mental Disorders / drug therapy
Mental Disorders / epidemiology
Mental Disorders / etiology*
Nursing Homes*
Psychotropic Drugs / therapeutic use*
Risk Factors

Substances

Psychotropic Drugs