A Longitudinal Examination of Agitation and Resident Characteristics in the Nursing Home

Abstract

Purpose: Agitation frequently accompanies cognitive decline among nursing home residents. This study used cross-sectional and longitudinal (up to 18 months) methods to examine agitation among profoundly and moderately impaired residents using both staff report and direct observation methods. Design and Methods: The study included participants (N = 78) from a larger study who completed either 12 or 18 months of data collection. There were four measurement points, each separated by 6-month intervals. We recorded agitation using two measures: (a) the computer-assisted behavioral observation system (CABOS) and (b) the staff-completed Nursing Home Behavior Problem Scale. We used longitudinal hierarchical linear modeling to capture the dynamic nature of behavior change as a function of individual resident characteristics and time. Results: The profoundly cognitively impaired residents (M Mini-Mental State Examination [MMSE] score = 1.7) displayed more agitation than the moderately impaired group (M MMSE score = 15.4) at Epoch 1 (cross-sectional analyses). Longitudinal analysis found a significant linear and quadratic trend only with the profoundly impaired residents using the CABOS. These residents showed slight improvements in agitation up to 12 months, with agitation increasing significantly from 12 to 18 months. Implications: With nursing homes receiving an increasing number of profoundly cognitively impaired residents, these results have potential cost and policy implications. Measuring agitation over time by using both staff report and observation measures presents various problems, and we present an alternative measure that may help to avoid these difficulties.

Longitudinal course of behavioural and psychological symptoms of dementia: systematic review

“…In individuals with dementia, psychosis, hyperactivity, agitation and physical aggression were associated with greater cognitive impairment. 26,35,38,[63][64][65] In contrast, Marin et al found no association in dementia between cognitive impairment and depression, delusion, agitation and irritability. 66 Four studies found that symptoms increased with cognitive decline in the early stages of dementia and were most commonly seen in moderate dementia, followed by a declining or stable course in the final stages of dementia.…”

“…66 Four studies found that symptoms increased with cognitive decline in the early stages of dementia and were most commonly seen in moderate dementia, followed by a declining or stable course in the final stages of dementia. 35,63,64,67 Cognitive function at onset of wandering was found to differ by type of wandering behaviour; for example, results suggested that excessive walking was more common in mild dementia, whereas in severe dementia getting lost was more likely. 68 No association was found between cognitive function and depressive symptoms in those with dementia, 69,70 whereas in those without dementia and without depression at baseline, cognitive impairment at baseline was associated with an increase of depressive symptoms over time.…”

“…52,53,58 In dementia, psychosis, hyperactivity, agitation and physical aggression were associated with greater cognitive impairment. 35,38,[63][64][65]70 Symptoms may be most common in moderate dementia, followed by a declining or stable course in the final stages of dementia. 35,63,64 However, heterogeneity in the pattern of findings across studies investigating the associations between BPSD and cognitive function prevented us from drawing more specific conclusions.…”

The relationship between pain and disruptive behaviors in nursing home resident with dementia

“…For this study, the level of cognitive impairment, activities of daily living (ADL) impairment, and demographic characteristics (e.g., age and sex) represent background factors. These variables were selected as covariates because they have established relationships with both pain and disruptive behaviors [15-18] and may influence the relationship between pain and disruptive behaviors.…”

Agitation in patients with dementia: a systematic review of epidemiology and association with severity and course

“…Of the 17 studies that showed a significant relationship between agitation and disease severity, 11 (65%) were cross-sectional and six (35%) were longitudinal. Dementia severity in these 17 studies was evaluated by the Mini-Mental State Examination (MMSE) (n = 4) (Burgio et al, 2007;Hamuro et al, 2007;Kasai et al, 2015;O'Donnell et al, 2007), the Global Deterioration Scale (GDS) (n = 2) (Mulders et al, 2016;Steinberg et al, 2006), the Clinical Dementia Rating Scale (CDR; n = 4) (Helvik et al, 2016;Liu et al, 2007;Selbaek et al, 2014;Tanaka et al, 2015), both the MMSE and CDR (n = 2) (D'Onofrio et al, 2012;Peters et al, 2015), or studies did not specify (n = 5). Of these 17 studies showing significant results, agitation was reported as being measured by the NPI in four studies (Fernandez Martinez et al, 2008;Helvik et al, 2016;Peters et al, 2015;Tanaka et al, 2015), the CMAI in two studies (Mulders et al, 2016;Steinberg et al, 2008), and Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD) in one (Liu et al, 2007).…”