[Care requirements and psychosocial care problems in nursing homes]

Residential homes were initially conceptualized to offer relatively independent elderly people room and board, rather than the nursing, medical, and rehabilitative care provided in nursing homes. Yet in the Netherlands an increasing number of frail elderly people are cared for in residential homes. By means of standardized rating scales data were collected in 1991 on the ability to perform 12 activities of daily living (ADL), cognitive disabilities, frequency of mood and behavioural problems, and social activities of all 1045 residents of 12 homes. The mean age of the 842 women (80.6%) and 203 men (19.4%) in this sample was 84.9 years (SD = 6.1). Using cutoff points that indicated the presence of serious impairment, we found that 11.9% of the residents were severely disabled in ADL. Severe cognitive impairments were detected in 10.2%, mood and behavioural problems in 13.7% and lack of social contacts in 11.6%. Multivariate cluster analysis revealed five patterns of care requirements, ranging from slight assistance (61.4%) to continuous skilled nursing care (4.9%). Residents are not homogeneous in their care requirements: 12.1% were found in a cluster that indicated a selective need of social contacts, 11.6% clustered together because of mood disorders, and 10.0% was found to have serious problems in three areas (ADL, cognition and social activity), except mood. This study suggests that about 15% of the elderly in residential homes need intensive and round-the-clock (psychogeriatric) nursing care. We conclude that residential homes have become a major component of the Dutch health care system for frail elderly patients.