Aggressive behaviour in elderly people with dementia: A review

Abstract

SUMMARYThe progressive degeneration of the brain seen in dementia is often accompanied by behaviourai disturbances. Aggressive behaviour is one of the most serious of these disturbances and is a common cause for psychiatric referral, admission to hospital and drug treatment. In this article, we discuss the conceptual issues associated with defining aggressive behaviour in cognitively impaired patients. We then review the aetiology, epidemiology, methods of assessment, and management of aggressive behaviour in elderly people with dementia.

A 2-Year Follow-Up of Behavioural and Psychological Symptoms in Alzheimer’s Disease

“…Moreover, AD patients with persistent aggressiveness were significantly older. Persistent aggressiveness may significantly increase the inability of AD patients to cope with tasks of daily living [3,24,25]. Furthermore, it has been demonstrated that aggressiveness is associated with the presence of hallucinations in AD [6,25].…”

Clinical predictors of aggressive behaviour in Alzheimer's disease

“…They demonstrate very high recurrence rates and are strongly correlated with caregiver burden (Levy et al, 1996;Donaldson et al, 1997). The behavioural disturbance which causes the greatest impact on suerers and their carers is aggression (Patel and Hope, 1993). Caregivers who have been abused by patients are more likely to direct abusive behaviour back towards the patient in their care (Coyne et al, 1993).…”

“…Caregivers who have been abused by patients are more likely to direct abusive behaviour back towards the patient in their care (Coyne et al, 1993). Aggressive behaviour is one of the most frequent causes of institutionalization of dementia suerers and increases the requirement for hospitalization and drug treatment (Cohen-Mans®eld, 1986;Colerick and George, 1986;Patel and Hope, 1993).…”

“…However, there are conceptual diculties concerning the nature of aggressive behaviour in the cognitively impaired population. In particular, the notion of`intent to harm', which is a crucial element in functional de®nitions of aggressive behaviour, is dicult to assess, and probably inappropriate, in this population (Slater, 1980;Patel and Hope, 1993). Patel and Hope (1992a), in the development of the Rating Scale for Aggressive Behaviour in the Elderly (RAGE), de®ned aggressive behaviour as`an overt act, involving the delivery of noxious stimuli to (but not necessarily aimed at) another organism, object or self, which is clearly not accidental'.…”

The use of restraint in four general hospital emergency departments in Australia

“…These results may reflect ED patient demographics, staff perceptions of dangerous behaviours, 13 and/or gender differences in behaviours associated with restraint. Presence of a small number of particularly disturbed patients may also have influenced results.…”