REJECTION OF CARE, AGGRESSION, AND AGITATION IN PERSONS WITH DEMENTIA: A SYSTEMATIC REVIEW OF DEFINITIONS USED IN BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA MEASURES

Abstract

Introduction Objective: To examine how rejection of care, aggression, and agitation are described and operationalized in existing measures of dementia-related behaviors with a particular focus on whether these behaviors are conceptualized as separate phenomena in rating scales. Methods Methods: We identified instruments developed to measure behavioral symptoms of dementia from two systematic reviews. Additionally, we conducted a systematic review of English-language peer-reviewed articles published from 1980 to 2017 to update the previous list of the instruments and identify additional measures that were not captured in previous reviews. Results Results: 43 instruments (23 general behavior measures, 20 symptom-specific measures) developed to measure behavioral symptoms of dementia were examined. Of these, 25 (58.1%) included items related to rejection of care; 32 (74.4%) included items related to aggression; and 35 (81.4%) included agitation items. Descriptions and definitions of these behaviors were highly variable across the instruments. 13 of 23 general measures and 3 of 20 symptom specific measures included items measuring all three behaviors while the rest of the instruments included items measuring only one or two behaviors of our interest. Conclusions Conclusions: The review demonstrated that rejection, aggression, and agitation are measured in most scales, yet their operationalization is highly variable, and they are often not distinguished from each other. Researchers and clinicians need to consider each symptom in its own right and revise existing instruments to address possible misnomers to improve measurement of dementia behaviors. This research was funded by: None