Personality traits, challenging behavior and quality of care in residents with mental-physical multimorbidity in long term care facilities: the MAPPING-2 study
Nederlandse verpleeghuizen hebben steeds vaker bewoners met gerontopsychiatrische aandoeningen. Uit de recent uitgevoerde MAPPING-studie bleek dat bij deze bewoners vaak probleemgedrag voorkomt zoals wanen, hallucinaties, somberheid en agitatie.
Persoonlijkheidsproblematiek bij gerontopsychiatrische aandoeningen
Persoonlijkheidsproblematiek lijkt een rol te spelen bij deze bewoners maar daar is nog nauwelijks onderzoek naar verricht. Meer inzicht is nodig in de unieke kenmerken en de zorgbehoefte van deze groep mensen.
Doel en werkwijze
De MAPPING-2 studie van het Radboudumc, Amsterdam UMC, Universitair Medisch Centrum Groningen (UMCG) en het Trimbos-instituut analyseert de eerder verzamelde gegevens over de rol van persoonlijkheidsproblematiek bij 142 verpleeghuisbewoners met gerontopsychiatrische aandoeningen. In het tweede deel van de studie worden verpleeghuisbewoners met gerontopsychiatrische aandoeningen die ook probleemgedrag en persoonlijkheidsproblematiek hebben, hun familieleden, zorgverleners en inhoudelijke experts geïnterviewd om tot aanbevelingen te komen over zorgverbeteringen voor de verpleeghuisbewoners.
Samenvatting van de aanvraag
In recent years, many Dutch nursing homes have evolved towards centers for specialized care, providing care for specific patient groups like patients with mental-physical multimorbidity (MPM) without dementia. Although highly prevalent, empirical knowledge on their specific characteristics and care needs is limited. The MAPPING study, an observational study including 142 patients with MPM without dementia has shown that patients with MPM are rather heterogeneous regarding underlying psychiatric and medical morbidity, while they meet each other regarding the consequences of their multimorbidity, like the severity of frontal dysfunctioning and neuropsychiatric symptoms (NPS). The discrepancy between patients and nursing staff pertaining to care needs as well as the persistence of NPS after institutionalization demonstrate the complexity of these patients. Furthermore, data from the comparable SpeCIMeN-study, that also included patients with dementia, were published. As in the MAPPING-study, NPS were highly prevalent in all 163 patients. The high prevalence rates of NPS may be explained by underlying personality pathology. In both studies mentioned above more than 40% had a probable personality disorder in their medical history. While about half of the patients suffering from an (other) mental disorder have a comorbid personality disorder, only 6% of older patients receiving specialised mental health care are diagnosed with a personality disorder. Empirical data on personality pathology in non-demented nursing home residents are scarce. The MAPPING study is unique by having data on personality functioning from multiple sources: (1) medical history; (2) by the Dutch informant personality questionnaire (HAP); and (3) the HAP ‘present time’ (HAP-t). Where the HAP assesses 10 premorbid personality traits by collecting data from a close relative, the HAP-t addresses actual functioning and can be administered by the nursing staff. The aim of the MAPPING-2 study is to examine those residents with MPM and personality pathology displaying challenging behaviors. The study will focus on the prevalence and impact of maladaptive personality traits on challenging behavior. Also, the study aims to explore the views and preferences of a sample of residents with MPM, their relatives and members of their multidisciplinary care teams, in order to ultimately formulate a set of provisional recommendations for good quality of care and competences required for the care-staff. This mixed methods study consists of two parts: (1) a quantitative study using data from the original MAPPING study and (2) a qualitative study of residents with personality pathology, their relatives and members of the multidisciplinary care-staff In the quantitative part, data of all 142 nursing home residents with MPM from the MAPPING-study will be used. The main aim is to map the personality profiles as assessed with the HAP and the HAP-t and to analyze differences between these two assessments. Due to the lack of a close relative, data on the HAP are available for 76% participants, HAP-t assessments are available for all residents. A second study in this part will study the determinants of neuropsychiatric symptoms in the population (n=142) of the MAPPING-study. Primary outcomes of this study are the three behavioral clusters ‘hyperactivity’, ‘mood/apathy’, and ‘psychosis’ as identified in the original MAPPING-study. Potential determinants like personality traits as assessed with the HAP-t, cognition, frontal dysfuntioning, psychiatric comorbidity will be analyzed using logistic regression analysis controlled for age, sex and psychotropic drug use. The qualitative study consists of three consecutive parts. First, individual semi-structured interviews with newly recruited residents with MPM, personality pathology and clinically relevant hyperactive behavior and their relatives will be conducted. Participants will be recruited from nursing home units that have participated in the MAPPING-study. Second, team interviews of the multidisciplinary care-staff (elderly care physicians, psychologists, nurses and old age psychiater) will be held. Third, an expert meeting with a group of 15-20 national experts will be held. The aim of this latter part is, based on the qualitative interviews of residents, relatives and staff to come to a set of provisional recommendations for good quality of care and treatment and the competences that are required for staff to deliver such care. The multidisciplinary project group represent high quality expertise regarding the nursing home and old age psychiatry setting, as well as regarding mixed methods and quality of care research methodology. Given the availability of the quantitative data for part 1, we consider it feasible for the AIOTO to conduct an extensive qualitative study as described in part 2.