Residential care for elderly people: the prevalence of cognitive impairment and behavioural problems.

AIMS to investigate the prevalence of and interrelationship between cognitive impairment and behavioural problems in older people in residential care. SUBJECTS all those aged 65 years and over resident on one night in any type of residential care within the Leicestershire District Health Authority. METHODS an assessment form for each resident was completed by care staff. The assessment included demographic information and functioning (both mental and physical) during the previous week. Cognitive impairment was measured by the confusion sub-scale of the Crichton Royal Behavioural Rating Scale. RESULTS 6079 people were enumerated in 241 establishments, including hospitals, homes and hostels provided by the National Health Service (NHS), local authority social services and private and voluntary agencies. Thirty-eight percent (2219) were moderately or severely cognitively impaired and behavioural problems were present in 11.5%, most being associated with the presence of cognitive impairment. Compared with elderly people in private residential homes, residents in local authority (part III) homes had significantly higher odds of demonstrating offensive behaviour of 1.40 (95% confidence interval 1.11-1.78) after adjustment for age, sex and cognitive impairment. No significant association between number of patients in the home and the proportion exhibiting offensive behaviour was found in any of the non-NHS facilities. CONCLUSIONS this survey of old people in institutional care found that most of those with behavioural problems were cognitively impaired. This has implications for staff training in the management of behavioural problems in demented people.