Young adults with acquired brain injury in nursing homes in Glasgow

Objective: To survey the 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 1 February 2000 and 31 January 2001. Setting: Twenty-eight 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 (OPCS) 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 three 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, nine 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.