Impact of agitation in long‐term care residents with dementia in the United States

Abstract

Objectives To describe characteristics and compare clinical outcomes including falls, fractures, infections, and neuropsychiatric symptoms (NPS) among long‐term care residents with dementia with and without agitation. Methods A cross‐sectional secondary analysis of administrative healthcare data was conducted whereby residents with dementia residing in a long‐term care facility for ≥12 months were identified from the AnalytiCare LLC database (10/2010–06/2014) and were classified into mutually exclusive cohorts (Agitation Cohort or No‐Agitation Cohort) based on available agitation‐related symptoms. Entropy balancing was used to balance demographic and clinical characteristics between the two cohorts. The impact of agitation on clinical outcomes was compared between balanced cohorts using weighted logistic regression models. Results The study included 6,265 long‐term care residents with dementia among whom, 3,313 were included in the Agitation Cohort and 2,952 in the No‐Agitation Cohort. Prior to balancing, residents in the Agitation Cohort had greater dementia‐related cognitive impairment and clinical manifestations compared to the No‐Agitation Cohort. After balancing, residents with and without agitation, respectively, received a median of five and four distinct types of medications (including antipsychotics). Further, compared to residents without agitation, those with agitation were significantly more likely to have a recorded fall (OR = 1.58), fracture (OR = 1.29), infection (OR = 1.18), and other NPS (OR = 2.11). Conclusions Agitation in long‐term care residents with dementia was associated with numerically higher medication use and an increased likelihood of experiencing falls, fractures, infections, and additional NPS compared to residents without agitation, highlighting the unmet need for effective management of agitation symptoms in this population.

Barriers and facilitators to care for agitation and/or aggression among persons living with dementia in long-term care

“…Up to 60% of persons living with dementia (PLWD) in LTC experience agitation and/or aggression symptoms, with the prevalence varying based on dementia pathology and severity [ 1 ]. Although agitation and aggression are separate constructs, they are often presented together among PLWD in LTC [ 2 ].…”

“…that are highly likely to cause harm among the resident and others [ 4 – 6 ]. Agitation and/or aggression can adversely impact residents’ quality of life by increasing the likelihood of falls, fractures, and developing additional neuropsychiatric symptoms, as well as increasing the cost of care and the rate of institutionalization [ 1 , 7 ]. Corresponding caregivers often experience increased burnout, lower job satisfaction, stress, and worse psychological health [ 8 ].…”

Brexpiprazole for the Treatment of Agitation in Alzheimer Dementia

“…Agitation associated with dementia is defined as excessive motor activity (eg, pacing, rocking, restlessness), verbal aggression (eg, speaking excessively loudly, screaming), or physical aggression (eg, grabbing, pushing, throwing objects), which causes excess distress or disability and cannot be solely attributed to a suboptimal care environment or another disorder (International Psychogeriatric Association criteria). 1 Agitation in dementia is common 2 , 3 ; has a negative effect on patient functioning, health outcomes, and quality of life 3 , 4 , 5 ; increases caregiver distress and time spent caring 5 , 6 ; and may contribute to the patient being institutionalized. 7 Due to the lack of health-authority–approved pharmacological treatment options for agitation in dementia, physicians may prescribe off-label medications, 8 , 9 despite having insufficient information about dosing, efficacy, and safety.…”

Sensing the care: advancing unobtrusive sensing solutions to support informal caregivers of older adults with cognitive impairment

“…Usually, it is difficult to deal with the person exhibiting agitation specifically in long-term or at-home care settings. PwD demonstrating agitation are more likely to experience a rapid decline in physical health due to unexpected falls or fractures compared to PwD without agitation [171]. They are also susceptible to additional neuropsychiatric symptoms such as sleep impairment, depression, etc [171].…”

“…PwD demonstrating agitation are more likely to experience a rapid decline in physical health due to unexpected falls or fractures compared to PwD without agitation [171]. They are also susceptible to additional neuropsychiatric symptoms such as sleep impairment, depression, etc [171]. Therefore, in addition to posing risks to the safety of PwD, it also induces significant distress for caregivers and presents challenges in delivering the necessary assistance and care to PwD [172].…”