Temporal Patterning of Agitation and Stressors Associated With Agitation: Case Profiles to Illustrate the Progressively Lowered Stress Threshold Model

Abstract

BACKGROUND: Stressors in persons with dementia (PWD) are often unrecognized until serving to trigger challenging behaviors, such as agitation. OBJECTIVE: The purpose of this study was to examine temporal patterning of stressors associated with agitation in PWD as postulated in the progressively lowered stress threshold (PLST) model. STUDY DESIGN: Baseline data of agitation from an intervention study of 39 cognitively impaired elders residing in a long-term care facility were analyzed. A modified Cohen-Mansfield Agitation Inventory was used during a 3-week period to document the frequency of agitation twice weekly for an hour during estimated “peak levels of agitation.” Anecdotal notes documented stressors. RESULTS: Case profiles were developed to illustrate factors identified in the PLST model that may contribute to stress and cause agitation. CONCLUSIONS: Findings suggest that temporal patterning of agitated behaviors in PWD may be predictable based on the PLST model. Recognizing early signs of agitation and its underlying meaning can facilitate timely and appropriate intervention by psychiatric nurses.