Aggressive Behaviors Among Nursing Home Residents: Association With Dementia and Behavioral Health Disorders
Aggressive Behaviors Among Nursing Home Residents: Association With Dementia and Behavioral Health Disorders
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DOI：
10.1016/j.jamda.2018.09.010
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发表时间：
2018-12-01
影响因子：
7.6
通讯作者：
Temkin-Greener, Helena
中科院分区：
文献类型：
--
作者：
Cen, Xi;Li, Yue;Temkin-Greener, Helena
目的：我们测量了养老院（NH）居民中攻击行为（AB）的患病率和严重程度，并检查了行为健康障碍患者是否比其他人更容易表现出攻击行为。设置和参与者：分析样本包括2015年15，706个NH居民的3，270，713个第一最小数据集（MDS）评估。个体被确定为（1）仅患有行为健康障碍（分层分类为精神分裂症/精神病、双相情感障碍、人格障碍、药物滥用、抑郁/焦虑）;（2）仅患有痴呆症;（3）行为健康障碍和痴呆症;或（4）两者都没有。攻击性行为量表（ABS）根据4个MDS项目（言语、身体、其他行为症状和拒绝护理）测量所表现出的攻击性行为的程度。ABS评分范围为0 - 1 - 2，反映症状严重程度为无（ABS评分= 0）、轻度（ABS评分= 1-2）、中度（ABS评分= 3-5）和重度（ABS评分= 6- 1 - 2）。结果：行为健康障碍和痴呆的居民中，AB的患病率最高（23.1%），其次是痴呆（15.3%），行为健康障碍（9.3%），和两者都没有（5.3%）。在控制了个体危险因素和设施协变量后，仅行为健康障碍、仅痴呆、行为健康障碍和痴呆的居民出现重度AB的相对风险分别为2.47、5.50和9.42，中度或轻度AB的模式相似。与痴呆症患者相比，患有行为健康障碍的居民在养老院中表现出攻击性行为的可能性较小。因此，坊间报道的担心，攻击性行为主要是一个问题的居民与行为健康障碍，而不是那些与痴呆症，没有经验证明。(c)2018年AMDA -急性后和长期护理医学协会。
Objectives: We measured the prevalence and severity of aggressive behaviors (ABs) among nursing home (NH) residents and examined whether individuals with behavioral health disorders were more likely to exhibit aggressive behaviors than others.Setting and participants: The analytical sample included 3,270,713 first Minimum Data Set (MDS) assessments for residents in 15,706 NHs in 2015.Measures: Individuals were identified as having (1) behavioral health disorders only (hierarchically categorized as schizophrenia/psychosis, bipolar disorder, personality disorder, substance abuse, depression/anxiety); (2) dementia only; (3) behavioral health disorders and dementia; or (4) neither. The Aggressive Behavior Scale (ABS) measured the degree of aggressive behaviors exhibited, based on 4 MDS items (verbal, physical, other behavioral symptoms, and rejection of care). The ABS scores ranged from 0 to 12 reflecting symptom severity as none (ABS score = 0), mild (ABS score = 1-2), moderate (ABS score = 3-5), and severe (ABS score = 6-12). Bivariate comparisons and multinomial logistic regressions were performed.Results: Residents with behavioral health disorders and dementia had the highest prevalence of ABs (23.1%), followed by dementia only (15.3%), behavioral health disorders only (9.3%), and neither (5.3%). After controlling for individual risk factors and facility covariates, the relative risk of exhibiting severe ABs was 2.47, 5.50, and 9.42 for residents with behavioral health disorders only, dementia only, and behavioral health disorders and dementia, respectively, with a similar pattern for moderate or mild ABs.Conclusions: Residents with behavioral health disorders were less likely than residents with dementia to exhibit aggressive behaviors in nursing homes. Thus, anecdotally reported concerns that aggressive behaviors are primarily an issue for residents with behavioral health disorders, rather than those with dementia, were not empirically justified. (c) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.