Behavioral and Psychological Symptoms: A Contribution for their Understanding Based on the Unmet Needs Model

2017 ◽  
Vol 41 (S1) ◽  
pp. S657-S657
Author(s):  
A.R. Ferreira ◽  
S. Martins ◽  
C. Dias ◽  
M.R. Simões ◽  
L. Fernandes
Keyword(s):  
Nursing Homes ◽  
Unmet Needs ◽  
Psychological Symptoms ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Final Sample ◽  
Camberwell Assessment Of Need ◽  
Competing Interest ◽  
Behavioral And Psychological Symptoms

IntroductionBehavioural and psychological symptoms (BPSD) are frequent in dementia and their contribution to poor health outcomes is well recognized. Four major frameworks attempt an explanation their aetiology: biological, behavioural, environmental vulnerability and unmet needs models. The latter states that BPSD are symptoms of needs that are not being met due to patients’ decreased ability to communicate/fulfil them. This model also implies that if needs were met, BPSD would improve.AimsTo explore the relation between needs and BPSD, and describe which unmet needs were contributing to BPSD in an elderly sample.MethodsA cross-sectional study was conducted in three Portuguese nursing homes. All residents were considered eligible. However, those unwilling or unable to participate were excluded. For each elderly patient, needs were assessed with camberwell assessment of need for the elderly/cane and BPSD with European Portuguese neuropsychiatric inventory/NPI.ResultsThe final sample included 166 elderly with an average of 80.9(sd = 10.2) years. Significant correlations between NPI and unmet and global needs were found (rs = 0.181,P = 0.020; rs = 0.254,P = 0.001, respectively). Additionally, the unmet needs of daytime activities (P = 0.019), company (P = 0.028) and behaviour (P = 0.001), presented significant correlations with NPI.ConclusionIn this sample, a high number of unmet needs were found. The absence of daytime activities, company and behaviour contributed to the identified BPSD, which is in line with other studies also highlighting the importance of these needs in nursing homes. This not only provides a framework for understanding BPSD, but also points to the identification of unmet needs as pivotal in prevention and treatment of these symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Assessment of antipsychotic prescribing in Belgian nursing homes

2011 ◽  
Vol 23 (8) ◽  
pp. 1240-1248 ◽  
Author(s):  
Majda Azermai ◽  
Monique Elseviers ◽  
Mirko Petrovic ◽  
Luc van Bortel ◽  
Robert Vander Stichele
Keyword(s):  
Nursing Homes ◽  
Inappropriate Prescribing ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Prescribing Indicators ◽  
Prescribing Quality ◽  
Homes For The Elderly ◽  
Combined Use ◽  
Antipsychotic Prescribing

ABSTRACTBackground: Given the potential adverse effects of antipsychotics, high use in nursing homes creates concern. Our study goal was to explore the use of antipsychotics in relation to resident characteristics, and to assess the appropriateness of antipsychotic prescribing in Belgian nursing homes.Methods: Data were used from a cross-sectional study (Prescribing in Homes for the Elderly; PHEBE) conducted in 76 nursing homes in Belgium. Antipsychotics were classified into typical and atypical, using the anatomical therapeutic and chemical classification. Ten inappropriate antipsychotic prescribing indicators were selected from the updated Beers criteria (2003), Bergen District Nursing Home Study (BEDNURS) indicators, and Screening Tool of Older People's Prescriptions criteria (STOPP).Results: The residents' mean age was 84.8 years, 78.1% of whom were female. The prevalence of antipsychotic utilization was 32.9%. Antipsychotics were mainly indicated for dementia-related agitation, and psychosis with/without dementia. Higher use of antipsychotics was found for dementia (OR: 3.27; 95% CI: 2.61–4.09), insomnia (OR: 1.38; 95% CI: 1.10–1.73), depression (OR: 1.30; 95% CI: 1.03–1.65), and age <80 years (OR: 1.79; 95% CI: 1.38–2.33). Inappropriate antipsychotic prescribing indicators scoring the highest among users were: long-term use (92.6%), use despite risk of falling (45.6%), combined use with other psychotropics (31.8%), and duplicate use (15.1%). Inappropriate prescribing was associated with depression (OR: 3.41) and insomnia (OR: 2.17).Conclusion: The indicator-driven analysis of antipsychotic prescribing quality revealed a need for improvement, with the main prescribing problems relating to duration and combination of therapies. Risks/benefits of off-label use need to be evaluated more consciously at the start of therapy, and at periodic re-evaluations.

Dementia severity among institutionalized elderly: Are there more unmet needs?

2016 ◽  
Vol 33 (S1) ◽  
pp. S187-S188
Author(s):  
A.R. Ferreira ◽  
S. Martins ◽  
C.C. Dias ◽  
L. Fernandes
Keyword(s):  
Cognitive Decline ◽  
Unmet Needs ◽  
The Elderly ◽  
Significant Negative Correlation ◽  
Cross Sectional Study ◽  
Active Management ◽  
Psychotic Symptoms ◽  
Ageing Population ◽  
Cross Sectional ◽  
Dementia Severity

IntroductionThe ageing population and the resulting increase in chronic diseases, including dementia, make the evaluation of their emergent needs a crucial step in psychogeriatric care. Unmet needs are found to be important clinical targets that should be followed by active management in order to improve health status and survival.ObjectivesTo analyze the relation between unmet needs and cognition, and explore the nature of these needs across dementia severity stages.MethodsA cross-sectional study was conducted in three nursing homes. Residents were excluded if they were terminally ill, unresponsive or presented delirium. All participants were assessed by Mini-Mental State Examination/MMSE (cognition) and Camberwell Assessment of Need for the Elderly/CANE (needs). Additionally, cognitive decline was staged as: absent (MMSE = 30), questionable (26–29), mild (21–25), moderate (11–20) and severe (≤ 10).ResultsThe study included 175 elderly with a mean age of 80.6 (SD = 10.1) years, of which 58.7% presented cognitive decline. For these, the mean number of unmet needs was greater than for those without (4 vs 3, P < 0.001), and they differed significantly in the domains of daytime activities (P < 0.001), memory (P < 0.001) and psychotic symptoms (P = 0.005). A significant negative correlation was found between MMSE and number of unmet needs (rs = −0.369, P < 0.001). Considering the severity stages, unmet needs also differed: more needs in early stages in daytime activities (73.3%), and in advanced ones in memory (63.9%) and psychotic symptoms (23%).ConclusionsGreater cognitive decline was related with more unmet needs, which agree with previous studies. The different nature of needs across severity stages also suggests that interventions should be tailored comprising this specificity and complexity, when effective care is planned.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Evaluation of Dependence Among Benzodiazepines in Population of Elderly Subjects Followed in Psychiatric Service in Sfax

2017 ◽  
Vol 41 (S1) ◽  
pp. S660-S660
Author(s):  
N. Messedi ◽  
I. Feki ◽  
I. Baati ◽  
R. Sellami ◽  
D. Trigui ◽  
...  
Keyword(s):  
Psychotropic Drugs ◽  
Psychiatric Service ◽  
Public Health Problem ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Elderly Subjects ◽  
Major Public Health Problem ◽  
Cross Sectional ◽  
Competing Interest ◽  
Withdrawal Signs

IntroductionBenzodiazepines (BZD) are the most consumed psychotropic drugs by the elders. This prescription can lead to the dependence which is a major public health problem particularly in this population.ObjectivesTo study the prevalence of dependence of the (BZD) in elderly subjects followed as outpatients and to identify the factors associated with it.MethodsIt was a cross-sectional study of 60 patients aged 65 years and older followed at the psychiatric consultation of the UH Hédi Chaker of Sfax; for 3 months. We used:– Questionnaire containing demographic and clinical data.– The cognitive scale of attachment to benzodiazepines (ECAB), a score ≥ 6 indicates dependence.ResultsThe average age of patients was 67.78 years, with a sex-ratio M/W = 0.46. They were smoking in 58.3% of cases. The most frequent psychiatric disorders were mood disorders (40%) followed by anxiety disorders (13.3%). The absence of diagnosis was observed in 23.3% of cases. A psychotropic drugs were associated with BZD in 86.7%. The most prescripted BZD was lorazépam (90%). Withdrawal signs were present in 90% of cases. The prevalence of BZD dependence has been estimated at 80%.BZD dependence was significantly correlated with smoking (P = 0.00), with psychotropics association (P = 0.04) and with signs of withdrawal (P = 0.001).ConclusionIt appears from our study the importance of BZD dependence in the elderly what it is a source of withdrawal difficulty. So we need make more effort to comply with recommendations regarding the prescription of these molecules.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals GAMBARAN PERILAKU DAN CARA MERAWAT GIGI TIRUAN SEBAGIAN LEPASAN PADA LANSIA DI PANTI WREDHA MINAHASA INDUK

e-GIGI ◽  
2015 ◽  
Vol 3 (1) ◽  
Author(s):  
Pingkan E.O. Lengkong ◽  
Damajanti H. C. Pangemanan ◽  
Ni Wayan Mariati
Keyword(s):  
Nursing Homes ◽  
The Elderly ◽  
Descriptive Study ◽  
Cross Sectional Study ◽  
Chemical Solution ◽  
Sectional Study ◽  
Inclusion Criteria ◽  
Missing Teeth ◽  
Cross Sectional

Abstract: Removable partial dentures (RPDs) is a denture that replaces one or more missing teeth in the maxilla or mandible and can be removed by the patient. Patients maintain hygiene habits removable partial dentures can be seen from the frequency, time, and method used to clean dentures varies between individuals and different communities. The purpose of this study is to describe the behavior and how to care RPDs for the elderly in Panti Wredha Minahasa.This type of research is a descriptive study with cross sectional study. The samples were all elderly who meet the inclusion criteria were age 60-80 years using RPDs in seven nursing homes in Minahasa.Based on the research that has been conducted, most respondents RPDs cleaning by brushing without toothpaste 1 (3.3%) and brushing with toothpaste totaled 29 respondents (96.67%). A total of 13 respondents (43.3%) did immersion RPDs. Most respondents simply did immersion by using water that are 17 respondents (56.67%), and no one do immersion using a chemical solution. Most respondents, 13 respondents (43.3%) RPDs cleaning once a day, as many as 28 respondents (93.33%) did not find any difficulty in cleaning RPDs, all respondents (100%) did not get instruction after assembling, as many as 22 respondents (73.3%) using RPDs at night when sleeping.Conclusion: from the study based on behavior, most respondents use RPDs at night when sleeping. Based on how to brush, most respondents RPDs cleaning by brushing use a toothbrush and toothpaste. Based on how to care for the soaking, most respondents did soaking with water.Keywords: removable partial dentures, elderlyAbstrak: Gigi tiruan sebagian lepasan (GTSL) adalah gigi tiruan yang menggantikan satu atau beberapa gigi yang hilang pada rahang atas atau rahang bawah dan dapat dilepas oleh pasien. Kebiasaan pasien memelihara kebersihan gigi tiruan sebagian lepasan dapat dilihat dari frekuensi, waktu, dan cara yang digunakan untuk membersihkan gigi tiruan bervariasi pada setiap individu dan masyarakat yang berbeda. Tujuan dari penelitian ini yaitu untuk mengetahui gambaran perilaku dan cara merawat GTSL pada lansia di Panti Wredha Minahasa Induk. Jenis penelitian ini yaitu penelitian deskriptif dengan pendekatan cross sectional study. Sampel adalah semua lansia yang memenuhi kriteria inklusi yaitu yang berusia 60-80 tahun, menggunakan GTSL di tujuh Panti Wredha di Minahasa Induk. Berdasarkan hasil penelitian yang telah dilakukan, responden paling banyak membersihkan GTSL dengan cara menyikat tanpa pasta gigi 1 orang (3,3%) dan menyikat gigi dengan pasta gigi berjumlah 29 responden (96,67%). Sebanyak 13 responden (43,3%) tidak melakukan perendaman GTSL. Responden terbanyak hanya melakukan perendaman dengan menggunakan air yaitu 17 responden (56,67%), dan tidak seorangpun yang melakukan perendaman dengan menggunakan larutan zat kimia. Sebagian besar responden yaitu 13 responden (43,3%) membersihkan GTSL sekali sehari, sebanyak 28 responden (93,33%) tidak menemukan kesulitan dalam membersihkan GTSL, semua responden (100%) tidak mendapatkan isntruksi setelah pemasangan, sebanyak 22 responden (73,3%) menggunakan GTSL pada saat malam hari ketika tidur. Simpulan: dari hasil penelitian berdasarkan perilaku, sebagian besar responden menggunakan GTSL pada saat malam hari ketika tidur. Berdasarkan cara menyikat, responden paling banyak membersihkan GTSL dengan cara menyikat memakai sikat gigi dan pasta gigi. Berdasarkan cara merawat dengan merendam, sebagian besar responden melakukan perendaman dengan menggunakan air.Kata kunci : gigi tiruan sebagian lepasan, lansia

scholarly journals Behavioral and psychological symptoms and hippocampal atrophy in subcortical ischaemic vascular disease

2012 ◽  
Vol 6 (3) ◽  
pp. 175-179
Author(s):  
Chan Tiel ◽  
Felipe Kenji Sudo ◽  
Carlos Eduardo Oliveira Alves ◽  
Gilberto Sousa Alves ◽  
Letice Ericeira-Valente ◽  
...  
Keyword(s):  
Psychological Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Vascular Cognitive Impairment ◽  
Cross Sectional Study ◽  
Hippocampal Atrophy ◽  
Clinical Dementia Rating ◽  
Cross Sectional ◽  
Fazekas Scale ◽  
The Impact ◽  
Behavioral And Psychological Symptoms

ABSTRACT Background: Neuropsychiatric symptoms are common in patients with cognitive impairments, mediated by both neurodegenerative processes and cerebrovascular disease. Previous studies have reported that Behavioral and Psychological Symptoms of Dementia (BPSD) might correlate with severity of cognitive decline. Thus far, the impact of the association between white-matter hyperintensities (WHM) and hippocampal atrophy (HA) on the incidence of these symptoms has been less studied. Objective: This cross-sectional study aimed to describe the clinical profile of a sample with large extensions of WMH, examining the association between different degrees of HA and cognitive, functional, and behavioral status. Methods: Fifty outpatients (mean age: 76.86±8.70 years; 58% female; mean schooling: 7.44±4.69 years) with large extensions of WMH (modified-Fazekas scale=3) on MRI and different degrees of hippocampal atrophy (according to de Leon Score) underwent cognitive, functional, and behavioral assessments. Results: Patients with mild-moderate to severe HA had worse performance on the Mini-Mental State Examination, Cambridge Cognitive Examination, Clinical Dementia Rating and Pfeffer's Functional Activities Questionnaire, compared to the group with none or questionable HA. Appetite/Eating Behavior was the only cluster of neuropsychiatric symptoms associated with presence of HA in Vascular Cognitive Impairment patients. Discussion: Although HA may exhibit distinct impact on cognitive performance and functional status, it appears to have little effect on behavioral symptoms in patients with high severity WMH.

scholarly journals Association between poor sleep quality and depression symptoms among the elderly in nursing homes in Hunan province, China: a cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e036401
Author(s):  
Zhao Hu ◽  
Xidi Zhu ◽  
Atipatsa Chiwanda Kaminga ◽  
Tingting Zhu ◽  
Yu Nie ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Sleep Quality ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Hunan Province ◽  
Depression Symptoms ◽  
Poor Sleep ◽  
Poor Sleep Quality ◽  
Cross Sectional ◽  
The Mean

ObjectivesTo examine the association between the prevalence of poor sleep quality and depression symptoms among the elderly in the nursing homes of Hunan province in China.Design, Setting and participantsThis was a cross-sectional study investigating 817 elderly people from 24 nursing homes in China’s Hunan province.Main outcome measuresSleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) such that poor sleep quality was defined as PSQI Score >5. In addition, depression symptoms were assessed using the Geriatric Depression Scale (GDS). Linear regression models and binary logistic regression models were used to analyse the relationship between the prevalence of poor sleep quality and depression symptoms.ResultsThe mean PSQI Score was 8.5±4.9, and the prevalence of poor sleep quality was 67.3%. Additionally, the mean GDS Score was 9.8±7.5, and the prevalence of depression symptoms was 36.0%. Elderly people with poor sleep quality had increased GDS Score (mean difference=2.54, 95% CI 1.66 to 3.42) and increased risk of depression symptoms (OR=3.19, 95% CI 2.04 to 4.98) after controlling for demographics, chronic disease history, lifestyle behaviours, social support, activities of daily living and negative life events.ConclusionsThe prevalence of poor sleep quality was relatively high, and this was associated with increased depression symptoms. Therefore, poor sleep quality could be speculated as a marker of current depression symptoms in the elderly.

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