Predictors of Agitation in Nursing Home Residents

Abstract

Agitation in nursing home residents presents a serious challenge to caregivers and may place residents at risk for harm. Understanding the etiology of agitation can assist clinicians in developing nonpharmacologic interventions for preventing and treating this problem. The purpose of this study was to examine independent and common predictors of resident agitation with structural equation modeling. Agitation was measured with both a standardized staff report rating scale and direct behavioral observation. No indirect or mediating effects were found. Cognitive impairment, vision and hearing impairment, and gender were found to be independent predictors of agitation as measured by direct behavioral observation. Only cognitive impairment was found to be predictive of agitation as measured by the standardized staff report scale. An unexpected finding was that vision impairment appeared to exert a protective effect for agitation in these severely cognitively impaired residents. The clinical implications of these findings are discussed as well as the relative merits of the two methods of measuring agitation.

Social Interaction, Premorbid Personality, and Agitation in Nursing Home Residents With Dementia

“…Vance et al (2003) reported similar findings. One reason for discrepancy across raters may be a response set bias for staff who come to expect certain behaviors from individual residents whether they are exhibited on a particular day.…”

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

“…We and others have argued in past research that staff-reported estimates of agitation underestimate agitation (McCann et al, 1997;Vance, Burgio et al, 2003). The current data suggest that staff-report measures are relatively insensitive to change over time.…”

“…Beck and colleagues (1998), for example, found that cognitive impairment based on the Mini-Mental State Examination (MMSE) score was the most significant predictor of agitation and that more cognitive impairment was associated with a higher incidence of agitation. Similarly, Vance, Burgio, et al (2003) reported that cognitive impairment was the most consistent predictor of agitation as measured by both staff report and direct observation. Evidence from these cross-sectional studies suggests that agitation increases as individuals' cognitive functioning worsens with dementia progression.…”

“…Agitation typically includes four subcategories, although the classifications and names may vary across studies: physically aggressive, physically nonaggressive, verbally aggressive, and verbally nonaggressive (Beck et al, 1998;Cohen-Mansfield & Werner, 1998a;Teri, Hughes, & Larson, 1990). Research has estimated that 30% to 84% of residents in nursing homes exhibit some form of agitation associated with dementia (American Health Care Association, 2005; Vance, Burgio, et al, 2003). Researchers have reported that agitation exhibited by residents is linked to caregiver burden, staff burnout, psychological distress, inadequate medical assessment, and inadequate management of residents' other health conditions (Cohen-Mansfield, 1995;Jackson et al, 1999).…”

“…In cross-sectional studies, cognitive impairment has received considerable attention in predicting agitation among individuals with dementia (GruberBaldini et al, 2004;Levy et al, 1996;Schultz et al, 2002;Vance, Burgio, et al, 2003). Beck and colleagues (1998), for example, found that cognitive impairment based on the Mini-Mental State Examination (MMSE) score was the most significant predictor of agitation and that more cognitive impairment was associated with a higher incidence of agitation.…”