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Behavioural and psychological symptoms in general hospital patients with dementia, distress for nursing staff and complications in care: results of the General Hospital Study

Published online by Cambridge University Press:  09 January 2017

J. B. Hessler Open the ORCID record for J. B. Hessler [Opens in a new window] ,
M. Schäufele ,
I. Hendlmeier ,
M. N. Junge ,
S. Leonhardt ,
J. Weber  and
H. Bickel
J. B. Hessler*
Affiliation:
Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Germany
M. Schäufele
Affiliation:
Faculty of Social Work, Mannheim University of Applied Sciences, Mannheim, Germany
I. Hendlmeier
Affiliation:
Faculty of Social Work, Mannheim University of Applied Sciences, Mannheim, Germany
M. N. Junge
Affiliation:
Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Germany
S. Leonhardt
Affiliation:
Faculty of Social Work, Mannheim University of Applied Sciences, Mannheim, Germany
J. Weber
Affiliation:
Faculty of Social Work, Mannheim University of Applied Sciences, Mannheim, Germany
H. Bickel
Affiliation:
Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Germany
*
*Address for correspondence: J. B. Hessler, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, D-81675 München, Germany. (Email: johannes.hessler@tum.de)
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Abstract

Aims.

Little is known about how behavioural and psychological symptoms of dementia (BPSD) manifest in the general hospital. The aim was to examine the frequency of BPSD in general hospitals and their associations with nursing staff distress and complications in care.

Methods.

Cross-sectional representative study with 1469 patients aged ≥65, including 270 patients with dementia, of 33 randomly selected general hospitals in Germany. BPSD and complications were reported by nurses.

Results.

Overall frequency of BPSD was higher in patients with dementia (76%) than without (38%). The most frequent symptoms in patients with dementia were nighttime disturbances (38%), depression (29%) and aberrant motor behaviour (28%) and the most distressing symptoms for nursing staff were delusions, aggression and nighttime disturbances. The overall frequency of BPSD increased from 67% in mild dementia, to 76% in moderate dementia and to 88% in severe dementia. The most frequent symptoms in patients without dementia were depression (19%), nighttime disturbances (13%) and irritability (13%). The most distressing symptoms were aggression and delusions, while the same symptoms were consistently rated as less distressing than in patients with dementia. Factor analysis revealed three independent groups of BPSD that explained 45% of the total variance. First, expansive symptoms (aggression, irritability, nighttime disturbances, aberrant motor behaviour and disinhibition) were frequent, distressing for nursing staff and associated with many complications. Second, psychotic symptoms (delusions and hallucinations) were infrequent, distressing and associated with some complications. Third, affective symptoms (apathy, anxiety and depression) were frequent, non-distressing and associated with few complications. The results did not change when cases with delirium were excluded from both groups.

Conclusions.

BPSD are common in older hospital patients with dementia and associated with considerable distress in nursing staff, as well as a wide range of special treatments needs and additional behavioural and medical complications. Management strategies are needed to improve the situation for both patients and hospital staff.

Keywords

Acute hospitalbehavioural and psychological symptoms of dementiaBPSD
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 27 , Issue 3 , June 2018 , pp. 278 - 287
Copyright
Copyright © Cambridge University Press 2017 

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