Agitation in Older Persons with Dementia: A Research Synthesis

Abstract

(1) Caregiver stress can result in rapid turnover of qualified personnel thus negatively affecting the care of elderly agitated clients. Three areas of nursing research address the treatment of agitation in demented elders. Subject‐centered studies address the effect of interventions such as massage, familiar voices, and light. Environment‐centered studies address settings such as dining room location. Caregiver‐centered studies address variables such as staff educational level and staff‐client ratio. In spite of the promising findings testing these interventions, physical and chemical restraints are still being used ineffectively and often indiscriminately to treat agitation in cognitively impaired elders.

Close observation by ‘specials’ to promote the safety of the older person with behavioural disturbances in the acute care setting

“…Clear assessment criteria based on research evidence should be utilised so that formal screening of patients is made and that the real patient needs are evaluated (Michaud et al, 2007;Schofield, 2008). A comprehensive assessment of the older person with behavioural disturbances in the ward setting is vital given the unique multiple challenges of providing care to this vulnerable patient group (Borbasi et al, 2006;Williams-Burgess et al, 1996).…”

“…Nurses working in wards where older patients with behavioural disturbance are admitted with other co-morbidities, often voice concerns about their ability to care for these particular patients along with others in the ward (Borbasi, Jones, Lockwood, & Emden, 2006;Tolson, Smith, & Knight, 1999). These patients are associated with self-care deficits, cognitive impairment, compromised communication, confusion and agitated behaviours in addition to the multiple and unique needs of elderly patients (Borbasi et al, 2006;Williams-Burgess, Ugarriza, & Gabbai, 1996). This paper reports a pilot study, which examined an initiative at an acute hospital in Sydney, Australia, that used the concept of 'specialling' this vulnerable group of older patients with behavioural disturbances in ward situations.…”

Improving geriatric mental health nursing care: Making a case for going beyond psychotropic medications

“…Regardless of the prevalence of such treatment, it must only be undertaken as a last resort (Cummings 1995; Gerdner & Buckwalter 1994; Leroi et al 1999). Nursing treatments (observation tables for the evaluation of NDB, walking and cognitive stimulation programmes, life history, reminiscence therapy, prosthetic environment and physical organization) aimed at behaviours and the environment have been shown to be more effective than drugs and restraints (Cronin‐Stubbs 1997; Landreville et al 1998; Lehninger et al 1998; Teri et al 1999; Williams‐Burgess et al 1996). Despite this, studies report that 17% to 65% of elderly people in nursing homes are prescribed neuroleptic drugs (Beers et al 1988; Hagen & Armstrong‐Esther 1999; Snowdon 1999).…”