Young Adults with Acquired Brain Injury in Nursing Homes in Glasgow

TM McMillan MAppSci.,PhD.,FBPSs1,2

M Laurie MBChB2

Department of Psychological Medicine, University of Glasgow1 and Department of Public Health, Greater Glasgow NHS Board, Glasgow2

INTRODUCTION

Little seems to have been published specifically about young adults with acquired brain injury (ABI) who are resident in nursing homes. Existing studies describe elderly or mixed elderly and younger adults, mainly strokes. Although younger adults form a minority of nursing home residents, the fact of their relative youth emphasises a need to be included in service strategy for people with acquired brain injury (ABI). A strategy has been developed in Glasgow, which plans to provide a network of rehabilitation and care services to people with ABI of all severities, starting in hospital soon after injury and following through to the community. Components of this planned service are relevant for those with significant care needs in the medium or long term. Although recent work in Glasgow has informed this planning process with regard to the incidence of traumatic brain injury and disability, there was little information of this kind about adults with ABI in nursing homes or about the services they received. For this reason a survey of all young adults with ABI in Glasgow was undertaken.

ABSTRACT

Objective: To survey characteristics, level of disability and services received by young adults with acquired brain injury (ABI) resident in nursing homes in Greater Glasgow.

Design: Telephone survey of 75 nursing homes followed by a questionnaire survey and review of medication cardexes. Included were all people under 65 years with ABI resident in nursing homes in Greater Glasgow between 1st February 2000 and 31st January 2001.

Setting: 28 nursing homes in Greater Glasgow, Scotland (population 0.9 million).

Subjects: Young adults (16-64) with ABI.

Main outcome measures: Structured questionnaire, Barthel Index, Office of Population Census Survey Disability Form, review of medication cardexes.

Results: Information was obtained on all cases identified in 75 nursing homes. There were 92 people with ABI in 28 nursing homes; 43/92 were in 3 homes. Only 42 had inpatient rehabilitation preadmission. Severe disability (OPCS categories 7-10) was found in 54 cases and minimal/minor disability (OPCS categories 1-2) in 18. Thirty-two exhibited challenging behaviour, 9 of these were physically violent. Homes were staffed by unqualified assistants, supervised by nurses. No home itself offered rehabilitation, but some had accessed an NHS physical disability community team (28/92 cases) or other community teams (5/92). Proactive medical review was uncommon. Medication had been reviewed since admission in a minority (21/92). Most had regular visits from relatives.

Conclusions: There is a wide range of disability in nursing home residents in Greater Glasgow. Proactive, routine review of medical, rehabilitation and medication needs is rare as is rehabilitation pre and post discharge. This is serious given the likelihood of reduced intellectual and/or physical capacity in this population. Nursing homes should have hospital discharge reports that inform about immediate preadmission history, rationale for medication and placement. There is a need for regular and ongoing health service review of nursing home residents including potential for rehabilitation and return to community living.

Other unmet needs include accommodation for people with challenging behaviour (including some people with advanced HIV infection and Huntington's disease), social work input to the community Hub, system/network of a specialist social support (such as that previously provided by the Head Injury Trust, Scotland) vocational re-entry schemes and a service for people with ABI. Discussions are taking place to resolve these issues.

Clinical Message:

10/100,000 of the Glasgow population are young adults with acquired brain injury resident in nursing homes, with disability ranging from minimal to severe.

Nursing home records are often inadequate in terms of medical history leading to admission.

Rehabilitation pre and post-admission and medical review post-admission is relatively rare.

There is a need for ongoing, regular, systematic, review of rehabilitation and medication needs.

RECOMMENDATIONS:

1. Positive, regular review of medical, rehabilitation and medication needs of young adults with acquired brain damage in nursing homes, at least twice yearly.

2. Provision of formal rehabilitation as required.

3. Development of “specialist” nursing homes for young adults with acquired brain damage. Staff should have access to regular education and training events to maximise the service that they give and to allow continuation of therapy/management strategies.

Nursing homes should have copies of hospital discharge reports to inform regarding immediate history preadmission including prescription rationale.