From rural to urban areas: differences in behavioural and psychological symptoms of dementia in nursing home residents according to geographical location

Abstract

Background: We determined whether the prevalence of behavioural and psychological symptoms of dementia (BPSD) in institutionalized older adults differed according to the geographical location of different facilities.

Methods: This cross-sectional study covered 175 nursing homes (NH) in France (n = 6275; age, 86.0 ± 8.2 years; women, 73.7%). Information on NH residents' health status and NH structure and internal organization were recorded by the NH staff. Each participant was coded for the presence or absence of the following BPSD: aggressive, screaming, and wandering behaviours. NH were geographically defined as rural (<2000 inhabitants), low urban (2000 ≤ inhabitants < 10 000), intermediate urban (10 000 ≤ inhabitants < 100 000), or high urban (inhabitants ≥ 100 000).

Results: Adjusted binary logistic regressions showed that, compared with residents living in rural NH, those living in NH located in high-urban areas had a significantly higher risk of aggressiveness (odds ratio = 1.33; 95% confidence interval = 1.06-1.67) and screaming (odds ratio = 1.43; 95% confidence interval = 1.05-1.95). The likelihood of aggressiveness was also higher in residents living in NH located in intermediate-urban areas (odds ratio = 1.36; 95% confidence interval = 1.13-1.65).

Conclusions: Rurality seems to play a positive role in the expression of BPSD. If this hypothesis were confirmed, it would encourage NH staff to develop activities that explore rural potentials for the management of BPSD.

Keywords: dementia; geographic distribution; neuropsychiatric symptoms; older adults; rural; rurality.