Clinical, behavioral, and treatment differences in nursing facility residents with dementia, with and without pseudobulbar affect symptomatology

Daily crying prevalence and associated factors in older adult persons living in nursing homes: findings from a regional study

OBJECTIVES

The study aims to evaluate the prevalence of nursing home (NH) resident crying and associated factors at the individual and NH levels.

DESIGN

A regional retrospective study design has been used.

PARTICIPANTS AND SETTING

A total of 8875 residents, living in 105 NHs, were included.

MEASUREMENTS

The occurrence of an episode of crying on at least a daily basis in the last month was the dependent variable; independent variables were set at individual and at the NH levels as reported in the Val.Graf regional database.

RESULTS

A total of 1,443 (16.3%) residents reported daily episodes of crying over the last month. Several individual variables were significantly associated with crying; female gender (odds ratio [OR] 2.535, 95% confidence interval [CI] 2.069-3.107); sad, pained or worried facial expressions (OR 1.885, 95% CI 1.785-2.021); negative thoughts (OR 1.650, 95% CI 1.508-1.804); unrealistic fears (OR 1.410, 95% CI 1.295-1.534); anger with self or others (OR 1.141, 95% CI 1.043-1.248); repetitive anxious complaints/concerns (OR 1.136, 95% CI 1.045-1.235); clinical instability (OR 1.186, 95% CI 1.018-1.381); pain (OR 1.183, 95% CI 1.058-1.323); night restlessness (OR 1.180, 95% CI 1.100-1.267); communication problems (OR 1.169, 95% CI 1.051-1.300); and cognitive impairment (OR 1.086, 95% CI 1.019-1.156); all increased the likelihood of crying. Conversely, sociability (OR 0.866, 95% CI 0.805-0.932) and being involved in social based activities (OR 0.882, 95% CI 0.811-0.960) were protective against crying. However, the previously mentioned variables have explained only 35.9% of variance in daily crying.

CONCLUSIONS

Around one out of six residents living in NH cries on a daily basis, and the reasons are also at the individual level. Residents seem to cry for attachment and clinical needs and to express stress and unhappiness; more research is needed, aiming at discovering other factors associated with resident's daily crying. Copyright © 2017 John Wiley & Sons, Ltd.

Identification of pseudobulbar affect symptoms in the nursing home setting: Development and assessment of a screening tool

Pseudobulbar Affect (PBA) is a neurologic condition characterized by involuntary outbursts of crying and/or laughing disproportionate to patient mood or social context. Although an estimated 9% of nursing home residents have symptoms suggestive of PBA, they are not routinely screened. Our goal was to develop an electronic screening tool based upon characteristics common to nursing home residents with PBA identified through medical record data. Nursing home residents with PBA treated with dextromethorphan hydrobromide/quinidine sulfate (n = 140) were compared to age-, gender-, and dementia-diagnosis-matched controls without PBA or treatment (n = 140). Comparative categories included diagnoses, medication use and symptom documentation. Using a multivariable regression and best decision rule analysis, we found PBA in nursing home residents was associated with chart documentation of uncontrollable crying, presence of a neurologic disorder (e.g., Parkinson's disease), or by the documented presence of at least 2 of the following: stroke, severe cognitive impairment, and schizophrenia. Based on these risk factors, an electronic screening tool was created.

Prevalence of pseudobulbar affect symptoms and clinical correlates in nursing home residents

OBJECTIVE

Pseudobulbar affect (PBA) is a neurological disorder of emotional expression, characterized by uncontrollable episodes of crying or laughing in patients with certain neurological disorders affecting the brain. The purposes of this study were to estimate the prevalence of PBA in US nursing home residents and examine the relationship between PBA symptoms and other clinical correlates, including the use of psychopharmacological medications.

METHODS

A retrospective study was conducted between 2013 and 2014 with a convenience sample of residents from nine Michigan nursing homes. Chronic-care residents were included in the "predisposed population" if they had a neurological disorder affecting the brain and no evidence of psychosis, delirium, or disruptive behavior (per chart review). Residents were screened for PBA symptoms by a geropsychologist using the Center for Neurologic Study-Lability Scale (CNS-LS). Additional clinical information was collected using a diagnostic evaluation checklist and the most recent Minimum Data Set 3.0 assessment.

RESULTS

Of 811 residents screened, complete data were available for 804, and 412 (51%) met the criteria for the "predisposed population." PBA symptom prevalence, based on having a CNS-LS score ≥13, was 17.5% in the predisposed population and 9.0% among all nursing home residents. Those with PBA symptoms were more likely to have a documented mood disorder and be using a psychopharmacological medication, including antipsychotics, than those without PBA symptoms.

CONCLUSIONS

Pseudobulbar affect symptoms were present in 17.5% of nursing home residents with neurological conditions, and 9.0% of residents overall. Increasing awareness and improving diagnostic accuracy of PBA may help optimize treatment. Copyright © 2015 John Wiley & Sons, Ltd.

[Resident assessment instrument. Application options and relevance for Germany]

The Resident Assessment Instrument (RAI) is a structured and standardized instrument to improve the quality of long-term care. It is based on the Minimum Data Set (MDS) 3.0 to generate clinical data for nursing planning. Further practical applications are calculation of the costs of nursing care (using a classification of residents), measurement and transparency of nursing home quality (using quality indicators) and epidemiological surveys (using uniform data from assessments). The RAI is used nationwide in the USA, to some extent in other countries and in Germany predominantly in the context of research. The paper briefly describes the historical development of the different RAI variations (particularly with respect to the MDS), presents the central utilization options and ends with a critical discussion of possibilities and limits of the RAI.