Prevalence of psychiatric vulnerability and neurocognitive disorders in nursing homes: impact on care levels.

Purpose: There is an increasing number of residents with more complex needs in nursing homes. Due to the deinstitutionalisation of mental health care, more individuals with psychiatric vulnerabilities are being referred to nursing homes. The aim of this study is to gain insight into the prevalence of psychiatric vulnerability in Belgian nursing homes and its impact on care levels.

Methods: After screening 3238 patient files of residents in twenty-four Belgian nursing homes, informed consent was obtained from 1155 of the 1608 residents or their legal representatives with a neurocognitive and/or psychiatric diagnosis. Residents were classified into three groups: residents with only a psychiatric diagnosis, with only a neurocognitive diagnosis, and both a psychiatric and neurocognitive diagnosis. The Health of Nations Outcome Scale 65 + was used to assess residents' behaviour, limitations, symptoms, and functioning.

Results: Of all residents, 17.5% had a lifetime psychiatric diagnosis and 41.8% had a neurocognitive disorder. Most prevalent were depressive disorder (8.2%) and Alzheimer's disease (19.3%). Scores for behavioural problems (1.4 and 1.4 versus 0.9, p < 0.0001) and symptoms (5.5 and 5.1 versus 4.4, p < 0,0001) were higher in residents with only a psychiatric or both diagnoses compared to those with only neurocognitive disorders. Conversely, scores for limitations were higher in residents with only a neurocognitive disorder (3.6 versus 2.2 and 3.1, p < 0.0001).

Conclusion: With almost 1 in 5 nursing home residents having a psychiatric vulnerability with higher levels of symptoms and behavioural problems, more attention towards improving nursing home caregivers' competence in psychiatric care is recommended.