Discomfort and agitation in older adults with dementia

Abstract

BackgroundA majority of patients with dementia present behavioral and psychological symptoms, such as agitation, which may increase their suffering, be difficult to manage by caregivers, and precipitate institutionalization. Although internal factors, such as discomfort, may be associated with agitation in patients with dementia, little research has examined this question. The goal of this study is to document the relationship between discomfort and agitation (including agitation subtypes) in older adults suffering from dementia.MethodsThis correlational study used a cross-sectional design. Registered nurses (RNs) provided data on forty-nine residents from three long-term facilities. Discomfort, agitation, level of disability in performing activities of daily living (ADL), and severity of dementia were measured by RNs who were well acquainted with the residents, using the Discomfort Scale for patients with Dementia of the Alzheimer Type, the Cohen-Mansfield Agitation Inventory, the ADL subscale of the Functional Autonomy Measurement System, and the Functional Assessment Staging, respectively. RNs were given two weeks to complete and return all scales (i.e., the Cohen-Mansfield Agitation Inventory was completed at the end of the two weeks and all other scales were answered during this period). Other descriptive variables were obtained from the residents' medical file or care plan.ResultsHierarchical multiple regression analyses controlling for residents' characteristics (sex, severity of dementia, and disability) show that discomfort explains a significant share of the variance in overall agitation (28%, p < 0.001), non aggressive physical behavior (18%, p < 0.01) and verbally agitated behavior (30%, p < 0.001). No significant relationship is observed between discomfort and aggressive behavior but the power to detect this specific relationship was low.ConclusionOur findings provide further evidence of the association between discomfort and agitation in persons with dementia and reveal that this association is particularly strong for verbally agitated behavior and non aggressive physical behavior.

Factors Affecting Verbal Agitation in Dementia Patients Living in Nursing Homes, South Korea

“…Gang et al [10] did not find the effect of cognitive function on physical agitation, but found that the duration of dementia, visual acuity, sleep quality, and physiological discomfort influenced physical agitation. On the other hand, with respect to verbal agitation, previous studies have identified severe pain [13], discomfort [16], and hallucination [35] as the influential factors, suggesting that verbal agitation is affected by sensory perceptual factors. The present study finding that hallucination, physiological discomfort, and pain affected verbal agitation is in line with these previous findings, in that they are health issues related to sensory perception.…”

“…In a study conducted by Pelletier and Landreville too [16], discomfort was found to affect verbal agitation. It is difficult for dementia patients to actively communicate physiological discomfort.…”

“…Cohen-Mansfield and Libin [15] reported that age, depression, cognitive impairment, activities of daily living (ADL), and impaired social functioning affected verbal agitation. Also, discomfort was reported by Pelletier and Landreville [16], and the severity of dementia by Zuidema et al [17], as a factor influencing verbal agitation.…”

Psicomotricidade e retrogênese: considerações sobre o envelhecimento e a doença de Alzheimer

“…A maioria dos pacientes com demência moderada ou avançada apresenta sintomas psicológicos e comportamentais que, além de aumentar o sofrimento, podem dificultar a assistência do cuidador e precipitar a institucionalização, sobretudo na presença de agitação 32 .…”

“…Apesar de estudo com autópsia não associar a hiperintensidade da substância branca com envelhecimento patológico 47 , estudos com neuroimagem corroboram a maior prevalência de depressão tardia, comprometimento cognitivo leve, DA, infartos lacunares e menores velocidade psicomotora e flexibilidade cognitiva 21,46,[48][49][50] . A presença de hiperintensidade da substância branca é inversamente proporcional à perfusão cerebral e localiza-se principalmente nas regiões periventriculares e no corpo caloso 32 , sendo o volume dessas alterações estruturais proporcional ao comprometimento cognitivo 48,51 . A alteração da substância branca tem evolução longitudinal e associase aos fatores de risco vasculares do paciente 34 , não sendo modificada ou revertida com o uso de vasodilatadores 45 .…”