Personality assessment in nursing home residents with mental and physical multimorbidity: two informant perspectives

Abstract

Objectives: In older patients with mental and physical multimorbidity (MPM), personality assessment is highly complex. Our aim was to examine personality traits in this population using the Hetero-Anamnestic Personality questionnaire (HAP), and to compare the premorbid perspective of patients’ relatives (HAP) with the present-time perspective of nursing staff (HAP-t). Design: Cross-sectional. Setting: Dutch gerontopsychiatric nursing home (GP-NH) units. Participants: Totally, 142 GP-NH residents with MPM (excluding dementia). Measurements: NH norm data of the HAP were used to identify clinically relevant premorbid traits. Linear mixed models estimated the differences between HAP and HAP-t trait scores (0–10). Agreement was quantified by intraclass correlation coefficients (ICCs). All HAP-HAP-t analyses were corrected for response tendency (RT) scores (−10–10). Results: 78.4% of the patients had at least one premorbid maladaptive trait, and 62.2% had two or more. Most prevalent were: “disorderly” (30.3%), “unpredictable/impulsive” (29.1%) and “vulnerable” (27.3%) behavior. The RT of relatives appeared significantly more positive than that of nursing staff (+1.8, 95% CI 0.6–2.9, p = 0.002). After RT correction, the traits “vulnerable”, “perfectionist” and “unpredictable/impulsive” behavior scored higher on the HAP than HAP-t (respectively +1.2, 95% CI 0.6–1.7, p < 0.001; +2.1, 95% CI 1.3–2.8, p < 0.001; +0.6, 95% CI 0.1–1.1, p = 0.013), while “rigid” behavior scored lower (−0.7, 95% CI −1.3 to −0.03, p = 0.042). Adjusted ICCs ranged from 0.15 to 0.58. Conclusions: Our study shows high percentages of premorbid maladaptive personality traits, which calls for attention on personality assessment in MPM NH residents. Results also indicate that the HAP and HAP-t questionnaires should not be used interchangeably for this patient group in clinical practice.