Abstract
BackgroundA majority of patients with dementia present behavioral and psychological symptoms, such as agitation, which may increase their suffering, be difficult to manage by caregivers, and precipitate institutionalization. Although internal factors, such as discomfort, may be associated with agitation in patients with dementia, little research has examined this question. The goal of this study is to document the relationship between discomfort and agitation (including agitation subtypes) in older adults suffering from dementia.MethodsThis correlational study used a cross-sectional design. Registered nurses (RNs) provided data on forty-nine residents from three long-term facilities. Discomfort, agitation, level of disability in performing activities of daily living (ADL), and severity of dementia were measured by RNs who were well acquainted with the residents, using the Discomfort Scale for patients with Dementia of the Alzheimer Type, the Cohen-Mansfield Agitation Inventory, the ADL subscale of the Functional Autonomy Measurement System, and the Functional Assessment Staging, respectively. RNs were given two weeks to complete and return all scales (i.e., the Cohen-Mansfield Agitation Inventory was completed at the end of the two weeks and all other scales were answered during this period). Other descriptive variables were obtained from the residents' medical file or care plan.ResultsHierarchical multiple regression analyses controlling for residents' characteristics (sex, severity of dementia, and disability) show that discomfort explains a significant share of the variance in overall agitation (28%, p < 0.001), non aggressive physical behavior (18%, p < 0.01) and verbally agitated behavior (30%, p < 0.001). No significant relationship is observed between discomfort and aggressive behavior but the power to detect this specific relationship was low.ConclusionOur findings provide further evidence of the association between discomfort and agitation in persons with dementia and reveal that this association is particularly strong for verbally agitated behavior and non aggressive physical behavior.
Highlights
A majority of patients with dementia present behavioral and psychological symptoms, such as agitation, which may increase their suffering, be difficult to manage by caregivers, and precipitate institutionalization
The goal of this study is to document the relationship between discomfort and agitation in older adults suffering from dementia
Residents were selected by the Registered nurses (RNs) according to the following criteria: (a) being at least 65 years old, (b) having a diagnosis of dementia documented by the medical file, and (c) having been living in the same facility for at least three months
Summary
A majority of patients with dementia present behavioral and psychological symptoms, such as agitation, which may increase their suffering, be difficult to manage by caregivers, and precipitate institutionalization. Internal factors, such as discomfort, may be associated with agitation in patients with dementia, little research has examined this question. In addition to cognitive symptoms, persons with dementia often present behavioral and psychological symptoms which may increase their suffering, be difficult to manage by caregivers, and precipitate institutionalization [4]. Between 50 and 90% of dementia patients present with behavioral or psychological symptoms [5]. A factor analysis of a measure of agitation used with nursing home residents produced three factors which make it possible to distinguish various forms of agitation [9]: aggressive behavior (AB, e.g., hitting), non-aggressive physical behavior (NAPB, e.g., pacing), and verbally agitated behavior (VAB, e.g., complaining)
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