title: 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.
authors.affiliation: Gérontopôle of Toulouse, Institute of Ageing, University Hospital of Toulouse (CHU Toulouse), Toulouse, France; UMR7268 Aix-Marseille University Biocultural Anthropology Laboratory, Marseille, France.
authors.forename: Philipe
authors.initials: P
authors.lastname: de Souto Barreto
authors.forename: Maryse
authors.initials: M
authors.lastname: Lapeyre-Mestre
authors.forename: Bruno
authors.initials: B
authors.lastname: Vellas
authors.forename: Yves
authors.initials: Y
authors.lastname: Rolland
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression / Q000523:psychology*; D001526:Behavioral Symptoms / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D015995:Prevalence; D012111:Residence Characteristics; D012424:Rural Population; D014505:Urban Population; D055816:Wandering Behavior / Q000523:psychology*
keywords: dementia; geographic distribution; neuropsychiatric symptoms; older adults; rural; rurality