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Different Patterns of Behavioral and Psychological Symptoms of Dementia and Caregiver Burden according to Dementia Type in Nursing Home Residents

요양시설 치매노인의 치매유형에 따른 행동심리증상 특성과 간호제공자의 업무 부담감

  • Received : 2016.04.15
  • Accepted : 2016.05.12
  • Published : 2016.05.31
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Abstract

The purpose of this study was to examine different patterns of behavioral and psychological symptoms of dementia (BPSD) and caregiver burden according to dementia type. Data were collected from June 2014 to December 2014 from five nursing homes. In all, 214 patients [131 patients with Alzheimer's disease (AD) and 83 patients with Vascular dementia (VD)] were included in the study. BPSD and caregiver burden data were examined using NPI-NH (Neuropsychiatric Inventory Nursing Home Version). According to the results, both the AD and VD group showed the highest frequency in apathy/indifference and the frequency of anxiety, elation/euphoria, and irritability/lability was significantly higher in the AD group than in the VD group. The difference in total BPSD composite scores between the AD and VD groups was not significant but agitation/aggression was significantly higher in the AD group than in the VD group. The mean score for caregiver burden was significantly higher in the AD group than in the VD group, particularly in agitation/aggression. In conclusion, BPSD differed according to dementia type, and nurses should provide specific interventions to control BPSD; a program to reduce caregiver burden according to dementia type is also needed.

본 연구는 요양시설 치매노인의 치매유형에 따른 행동심리증상 특성과 간호제공자의 업무 부담감 정도 차이를 파악하고자 시도되었으며, 자료 수집은 2014년 6월 1일부터 12월 31일까지 5개 노인요양시설에서 실시하였다. 총 214명(알츠하이머형 치매노인 131명, 혈관성 치매노인 83명)이 연구에 참여하였으며, 행동심리증상 특성과 간호제공자의 업무 부담감은 NPI-NH (Neuropsychiatric Inventory Nursing Home Version)를 활용하여 측정하였다. 연구 결과, 알츠하이머형 치매군과 혈관성 치매군 모두에서 무감동/무관심의 발생빈도가 가장 높았으며, 알츠하이머형 치매군이 혈관성 치매군에 비하여 불안, 들뜬 기분/다행감, 과민/불안정의 발생빈도가 유의하게 높았다. 전체 행동심리증상 점수는 알츠하이머형 치매군과 혈관성 치매군에서 유의한 차이가 없었으나, 세부영역에서 초조/공격성 점수는 알츠하이머형 치매군이 혈관성 치매군보다 유의하게 높았다. 전체 간호제공자의 업무 부담감은 알츠하이머형 치매군이 혈관성 치매군보다 유의하게 높았고, 특히, 알츠하이머형 치매군에서 초조/공격성의 업무 부담감 부분이 의미 있게 높았다. 결론적으로 요양시설 치매노인은 치매유형에 따라 행동심리증상정도에 차이가 있으므로 차별화된 간호가 필요하며, 간호제공자의 업무 부담감 감소를 위한 다양한 프로그램 개발 및 전략이 필요한 것으로 사료된다.

Keywords

References

  1. The Ministry of Health and Welfare, 2014 Elderly Survey [Internet], Seoul: The Ministry of Health and Welfare, 2015[cited 2015 Dec 15], Available from: http://www.mohw.go.kr/front_new/jb/sjb030301vw.jsp?PAR_MENU_ID=03&MENU_ID=0328&CONT_SEQ=318518&page=1
  2. National Center for Dementia, 2014 National Institute of Dementia Annual Report [Internet], Seoul: National Center for Dementia, 2015[cited 2015 Sep 15], Available from: http://www.nid.or.kr/dementia_center/notice/notice_view.asp?seq=1094&page=1&list_num=10&schType=TITL
  3. D. K. Kim, "Behavioral and Psychological Symptom in Dementia(BPSD)", Psychotic Symptoms. Journal of Korean Geriatirc Psychiatry, Vol.4, No.1 pp. 3-11, 2000.
  4. G. Selbæk, K. Engedal, S. Bergh, "The prevalence and course of neuropsychiatric symptoms in nursing home patients with dementia: a systematic review", Journal of the American Medical Directors Association, Vol.14, No. 3 pp. 161-169, 2013. DOI: http://dx.doi.org/10.1016/j.jamda.2012.09.027
  5. S. Finkel, "Introduction to behavioural and psychological symptoms of dementia (BPSD)", International Journal of Geriatric Psychiatry, Vol.15, NO.1 pp. S2-S4, 2000. DOI: http://dx.doi.org/10.1002/(SICI)1099-1166(200004)15:1+3.0.CO;2-3
  6. K. S. Kim, E. S. Choi, S. A. Park, "A Study on Behavioral and Psychological Symptom of Dementia(BPSD) among Dementia Elderly in an Institutional Setting", Journal of the Korean Gerontological Society, Vol.27, No.1 pp. 137-152, 2007.
  7. M. J. Chiu, T. F. Chen, P. K. Yip, M. S. Hua, L. Y. Tang, "Behavioral and psychologic symptoms in different types of dementia", Journal of the Formosan Medical Association, Vol.105, No.7 pp. 556-562, 2006. DOI: http://dx.doi.org/10.1016/S0929-6646(09)60150-9
  8. J. L. Cerejeira, Lagarto, E. Mukaetova-Ladinska, "Behavioral and psychological symptoms of dementia", Frontiers in Neurology, Vol.3, pp. 1-21, 2012. DOI: http://dx.doi.org/10.3389/fneur.2012.00073
  9. S. H. Ryu, J. H. Ha, D. H. Park, J. Yu, G. Livingston, "Persistence of neuropsychiatric symptoms over six months in mild cognitive impairment in community-dwelling Korean elderly", Int. Psychogeriatrics, Vol.23, No.2, pp. 214-220, 2011. DOI: http://dx.doi.org/10.1017/S1041610210001766
  10. J. J. Oh, "The Experience of Nursing Staff on the Dementia Patients' Aggressive Behavior", J Korean Med Sci, Vol.30, No.2, pp. 293-306, 2000.
  11. M. K. Jo, "A Study about Behavioral and Psychological Symptoms of Dementia(BPSD) and Burden of a Caregiver-Focused on a dementia center in Incheon", Gachon University MD, 2008.
  12. The Korean Academy of Clinical Geriatrics, Principles of Geriatric Medicine. Hankook book, 2005.
  13. D. Y. Lim, "Coping with Dementia related Behavior Problems of the Elderly and Care Providers" Journal of the Korea Academia-Industrial cooperation Society, Vol.16, No.7 pp. 4805-4815, 2015. DOI: http://dx.doi.org/10.5762/KAIS.2015.16.7.4805
  14. P. Proitsi, G. Hamilton, M. Tsolaki, M. Lupton, M. Daniilidou, et al., "A Multiple Indicators Multiple Causes (MIMIC) model of Behavioural and Psychological Symptoms in Dementia (BPSD)", Neurobiology of Aging, Vol.32, No.3 pp. 434-442, 2011. DOI: http://dx.doi.org/10.1016/j.neurobiolaging.2009.03.005
  15. M. E. Kunik, A. L. Snow, J. A. Davila, A. B. Steele, V. Balasubramanyam, et al., "Causes of aggressive behavior in patients with dementia", The Journal of clinical psychiatry, Vol. 71, N0.9 pp. 1145-1152, 2010. https://doi.org/10.4088/JCP.08m04703oli
  16. U. K. Braun, M. E. Kunik, "The psychiatric consultant. Behavioral disturbances in dementia: finding the cause(s)", Geriatrics, Vol.59, No.12 pp. 32, 2004.
  17. R. Howard, C. Ballard, J. O'Brien, A. Burns, "Guidelines for the management of agitation in dementia", International Journal of Geriatric Psychiatry, Vol.16, No.7 pp. 714-717, 2001. DOI: http://dx.doi.org/10.1002/gps.418
  18. S. U. Zuidema, J. F. M. de Jonghe, F. R. J. Verhey, R. T. C. Koopmans, "Environmental correlates of neuropsychiatric symptoms in nursing home patients with dementia", International Journal of Geriatric Psychiatry, Vol.25, No.1 pp. 14-22, 2010. https://doi.org/10.1002/gps.2292
  19. D.L. Algase, C. Beck, A. Kolanowski, A. Whall, S. Berent , et al., "Need-driven dementia-compromised behavior: An alternative view of disruptive behavior", American Journal of Alzheimer's Disease and Other Dementias, Vol. 11, No.6 pp. 10-19, 1996. DOI: http://dx.doi.org/10.1177/153331759601100603
  20. C. R. Kovach, P. E. Noonan, Andrea Matovina Schlidt, Thelma Wells, "A Model of Consequences of Need-Driven, Dementia-Compromised Behavior", Journal of Nursing Scholarship, Vol.37, No.2 pp. 134-140, 2005. DOI: http://dx.doi.org/10.1111/j.1547-5069.2005.00025_1.x
  21. C. Hsieh, C. Chang and C. Lin, "Neuropsychiatric profiles of patients with Alzheimer's disease and vascular dementia in Taiwan", International Journal of Geriatric Psychiatry, Vol.24, No.6, pp. 570-577, 2009. DOI: http://dx.doi.org/10.1002/gps.2156
  22. G. D'Onofrio, D. Sancarlo, F. Panza, M. Copetti, L. Cascavilla, et al.,, "Neuropsychiatric symptoms and functional status in Alzheimer's disease and vascular dementia patients", Current Alzheimer Research, Vol.9, No.6 pp. 759-771, 2012. DOI: http://dx.doi.org/10.2174/156720512801322582
  23. S. Srikanth, A. Nagaraja, E. Ratnavalli, "Neuropsychiatric symptoms in dementia-frequency, relationship to dementia severity and comparison in Alzheimer's disease, vascular dementia and frontotemporal dementia", Journal of the Neurological Sciences, Vol.236, No.1 pp. 43-48, 2005. DOI: http://dx.doi.org/10.1016/j.jns.2005.04.014
  24. T. K. Bandyopadhyay, A. Biswas, A. Roy, D. Guin, S. Gangopadhyay, et al., "Neuropsychiatric profiles in patients with Alzheimer's disease and vascular dementia". Annals of Indian Academy of Neurology, Vol.17, No.3 pp. 325-330, 2014. DOI: http://dx.doi.org/10.4103/0972-2327.138520
  25. D. K. Johnson, A. S. Watts, B. A. Chapin, R. Anderson, J. M. Burns, "Neuropsychiatric profiles in dementia", Alzheimer Disease and Associated Disorders Vol. 25, No. 4, pp. 326, 2011. DOI: http://dx.doi.org/10.1097/WAD.0b013e31820d89b6
  26. J. H, Kim, C. E, Lee, "A study on the frequency of problem behaviors in dementied elderly", Gerontolgy nurisng in Korea, Vo1.2, No.2 pp. 195-202, 2000.
  27. S. Wood, J. L. Cummings, M. A Hsu, T. Barclay, M. V. Wheatley, et al., "The Use of the Neuropsychiatric Inventory in Nursing Home Residents: Characterization and Measurement", The American Journal of Geriatric Psychiatry, Vol.8, No.1, pp. 75-83, 2000. DOI: http://dx.doi.org/10.1097/00019442-200002000-00010
  28. J. L. Cummings, M. Mega, K. Gray, S. Rosenberg-Thompson, D. A. Carusi, et al., "The Neuropsychiatric inventory comprehensive assessment of psychopathology in dementia", Neurology, Vol.44, No.12 pp. 2308, 1994. DOI: http://dx.doi.org/10.1212/WNL.44.12.2308
  29. S. H. Choi., D. K. Na., H. M. Kwon., S. J. Yoon., J. H. Jeong., et al., "The Korean version of the neurochiatric Inventory: A scoring tool for neuropsychion disturbance in dementia patients"; Journal of Korean Medical Society, Vol.15, pp. 609-615, 2000. DOI: http://dx.doi.org/10.3346/jkms.2000.15.6.609
  30. J. Aharon-Peretz, D. Kliot and R. Tomer, "Behavioral differences between white matter lacunar dementia and Alzheimer's disease: a comparison on the neuropsychiatric inventory", Dementia and Geriatric Cognitive Disorders, Vol. 11, No. 5, pp. 294-298, 2000. DOI: http://dx.doi.org/10.1159/000017252
  31. M. Fernandez Martinez, J. Castro Flores, S. Perez de las Heras, A. Mandaluniz Lekumberri, M. Gordejuela Menocal et al., "Prevalence of neuropsychiatric symptoms in elderly patients with dementia in mungialde county (Basque Country, Spain)", Dementia & Geriatric Cognitive Disorders, Vol. 25, No. 2, pp. 103-108, 2008. DOI: http://dx.doi.org/10.1159/000112215
  32. T. I. Sadak, J. Katon, C. Beck, B. B. Cochrane, S. Borson, "Key neuropsychiatric symptoms in common dementias: prevalence and implications for caregivers, clinicians, and health systems", Research in Gerontological Nursing, Vol. 7, No. 1, pp. 44, 2014. DOI: http://dx.doi.org/10.3928/19404921-20130918-01
  33. G. M. Savva, J. Zaccai, F. E. Matthews, J. E. Davidson, I. McKeith, et al., "Prevalence, correlates and course of behavioural and psychological symptoms of dementia in the population", The British Journal of Psychiatry, Vol. 194, No. 3, pp. 212-219, 2009. DOI: http://dx.doi.org/10.1192/bjp.bp.108.049619
  34. C. G. Lyketsos, C. Steele, L. Baker, E. Galik, S. Kopunek, et al., "Major and minor depression in Alzheimer's disease: prevalence and impact", The Journal of Neuropsychiatry & Clinical Neurosciences, Vol. 9, No. 4, pp. 556-561, 1997. DOI: http://dx.doi.org/10.1176/jnp.9.4.556
  35. G. L. Pagalilauan, "Psychiatric Diagnosis and Management in Primary care', Medical Clinics of North America, Vol. 98, No. 5, pp. 17-19, 2004.
  36. L. B. Zahodne, K. Ornstein, S. Cosentino, D. Devanand, Y. Stern, "Longitudinal relationships between Alzheimer disease progression and psychosis, depressed mood and agitation/aggression", The American Journal of Geriatric Psychiatry, Vol. 23, No. 2, pp. 130-140, 2015. DOI: http://dx.doi.org/10.1016/j.jagp.2013.03.014
  37. S. B. Koh, D. W. Yang, S. W. Jeong, Y. B. Choi, B. S. Kim, "The Different Patterns of Behavioral Derangements in Subcortical Vascular Dementia and Alzheimer's Disease-Evaluated by the Korean Version of the Neuropsychiatric Inventory", Journal of the Korean Neurological Association, Vol.20, No. 4, pp. 353-358, 2002.
  38. T. Y. Kim, S. Y. Kim, E. G. Kim, J. W. Kim, G. W. Park, et al., "The Differences of Behavioral and Psychological Symptoms in the Patients of Alzheimer's Disease and Vascular Dementia", Journal of the Korean Neurological Association, Vol.24, No.5 pp. 458-464, 2006.
  39. J. I. Kim, "Factors Affected Problem Behavior of the Elderly with Dementia in Elderly Care Facilities", The Korean Society of Living Environmental System, Vol.19, No.5 pp. 584-594, 2012.
  40. T. Majic, J. P. Pluta, T. Mell, Y. Treusch, H. Gutzmann, et al., "Correlates of agitation and depression in nursing home resident with dementia", International Psychogeriatrics, Vol.24, No.7 pp. 1779-1789, 2012. DOI: http://dx.doi.org/10.1017/S104161021200066X
  41. Y. S. Sim, B. S. Kim, Y. M. Son, G. S. Kim, B. R. Yun, et al., "Clinical Characteristics of Demented Patients in a Geriatric Institution: Focused on Behavioral and Psychological Symptoms", Dementia and Neurocognitive Disorders, Vol.4, No.1 pp. 35-40, 2005.
  42. Y. S. Byeon and J. J. Nam, "A Study on Disturbing Behaviors and Environment Characteristics in Elderly People with Dementia", The Korean Journal of Fundamentals of Nursing, Vol.9, No.2 pp. 246-256, 2002.
  43. J. Cohen-Mansfield, M. S. Marx, P. Werner, "Agitation in elderly persons: an integrative report of findings in a nursing home", International Psychogeriatrics, Vol.4, No.2 pp. 221-240, 1992. DOI: http://dx.doi.org/10.1017/S1041610292001285
  44. M. Benoit, I. Dygai, O. Migneco, P. H. Robert, C. Bertogliati, et al., "Behavioral and psychological symptoms in Alzheimer's disease. Relation between apathy and regional cerebral perfusion", Dementia and Geriatric Cognitive Disorders, Vol.10, No.6 pp. 511-517, 1999. DOI: http://dx.doi.org/10.1159/000017198
  45. O. Migneco, M. Benoit, P. M. Koulibaly, I. Dygai, C. Bertogliati, et al., "Perfusion Brain SPECT and Statistical Parametric Mapping Analysis Indicate That Apathy Is Cingulate Syndrome: A Study in Alzheimer's Disease and Nondemented Patients", Neuro Image, Vol.13, No.5 pp. 896-902, 2001. DOI: http://dx.doi.org/10.1006/nimg.2000.0741
  46. E. B. Fauth, A. Gibbons, "Which behavioral and psychological symptoms of dementia are the most problematic? Variability by prevalence, intensity, distress ratings, and associations with caregiver depressive symptoms", International Journal of Geriatric Psychiatry, Vol.29, No.3 pp. 263-271, 2014. DOI: http://dx.doi.org/10.1002/gps.4002
  47. N. Matsumoto, M. Ikeda, R. Fukuhara, S. Shinagawa, T. Ishikawa, et al., "Caregiver burden associated with behavioral and psychological symptoms of dementia in elderly people in the local community", Dementia & Geriatric Cognitive Disorders, Vol.23, No.4 pp. 219-224, 2007. DOI: http://dx.doi.org/10.1159/000099472
  48. S. S. Huang, M. C. Lee, Y. C. Liao, W. F. Wang, T. J. Lai, "Caregiver burden associated with behavioral and psychological symptoms of dementia (BPSD) in Taiwanese elderly", Archives of Gerontology and Geriatrics, Vol.55, No.1 pp. 55-59, 2012. DOI: http://dx.doi.org/10.1016/j.archger.2011.04.009
  49. J. A. Song, J. W. Park, H. J. Cheon, M. H. Park, "Development of Web-based Educational Program for Family Caregivers in Managing Behavioral and Psychological Symptoms of Dementia", Journal of Korean Gerontological Nursing, Vol.35, No.2 pp. 411-432, 2015.
  50. J. H. Kang, "Effect of a Social Support Program on Caregivers of Elders with Dementia", Journal of Korean Gerontological Nursing, Vol.12, No.2 pp. 142-153, 2010.
  51. S. G. Oh, "A Study on the Current State of Long-term Caregivers' Caring Activities and Policy Recommendations for the Improvement of Long-term Caregivers' Working Condition", Social Research, No.20 pp. 101-135, 2010.
  52. C. Hyun, Z. K. Zoo, "Current State of Senile Dementia and Improvement of the Long Term Care Insurance for Elderly People", Journal of the Korea Academia-Industrial cooperation Society, Vol.13, No.12 pp. 5816-5825, 2012. DOI: http://dx.doi.org/10.5762/KAIS.2012.13.12.5816
  53. L. M. Kuo, H. L. Huang, W. C. Hsu, Y. I. Shyu, "Health-Related Quality of Life and Self-Efficacy of Managing Behavior Problems for Family Caregivers of Vascular Dementia and Alzheimer's Disease Patients", Dementia and Geriatric Cognitive Disorders, Vol.38, No.5-6 pp. 310-320, 2014. DOI: http://dx.doi.org/10.1159/000360414