Psychometric evaluation of the Cohen‐Mansfield Agitation Inventory in an acute general hospital setting

Kupeli, Nuriye; Vickerstaff, Victoria; White, Nicola; Lord, Kathryn; Scott, Susan V.; Jones, Louise; Sampson, Elizabeth L

doi:10.1002/gps.4741

Cited by 15 publications

(9 citation statements)

References 38 publications

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“…Exploratory secondary analysis of data from a prospective longitudinal study investigating Behavioural and Psychological Symptoms in Dementia (BPSD) and pain in people with dementia in the acute hospital [ 17 ]. Detailed methodology for the study from previous analyses of this cohort are published elsewhere [ 18 – 20 ]. Ethical approval was obtained from the Central London Research Ethics Committee 3 (reference 10/HO716/79).…”

Section: Methodsmentioning

confidence: 99%

Pain and delirium in people with dementia in the acute general hospital setting

et al. 2018

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BackgroundPain and delirium are common in people with dementia admitted to hospitals. These are often under-diagnosed and under-treated. Pain is implicated as a cause of delirium but this association has not been investigated in this setting.ObjectiveTo investigate the relationship between pain and delirium in people with dementia, on admission and throughout a hospital admission.DesignExploratory secondary analysis of observational prospective longitudinal cohort data.SettingTwo acute hospitals in the UK.MethodologyTwo-hundred and thirty participants aged ≥70 years were assessed for dementia severity, delirium ((Confusion Assessment Method (CAM), pain (Pain Assessment in Advanced Dementia (PAINAD)) scale and prescription of analgesics. Logistic and linear regressions explored the relationship between pain and delirium using cross-sectional data.ResultsPain at rest developed in 49%, and pain during activity for 26% of participants during their inpatient stay. Incident delirium developed in 15%, of participants, and 42% remained delirious for at least two assessments. Of the 35% of participants who were delirious and unable to self-report pain, 33% of these participants experienced pain at rest, and 56 experienced pain during activity. The odds of being delirious were 3.26 times higher in participants experiencing pain at rest (95% Confidence Interval 1.03–10.25, P = 0.044).ConclusionAn association between pain at rest and delirium was found, suggesting pain may be a risk factor for delirium. Since pain and delirium were found to persist and develop during an inpatient stay, regular pain and delirium assessments are required to manage pain and delirium effectively.

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Section: Methodsmentioning

confidence: 99%

Pain and delirium in people with dementia in the acute general hospital setting

et al. 2018

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“…21 Also, the psychometric properties of CMAI underline link between aggressive behaviors and pain. 31 …”

Section: Limitationsmentioning

confidence: 99%

Pain as a challenge in nursing home residents with behavioral and psychological symptoms of dementia

Nowak¹,

Neumann-Podczaska²,

Deskur-Śmielecka³

et al. 2018

CIA

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IntroductionIn patients with dementia, observational scales are recommended for use in the assessment of pain. Unfortunately, their application is rare, and as a consequence pain is frequently underdiagnosed and undertreated in these types of subjects. Thus, the aim of the study was to assess analgesic treatment in nursing home residents with cognitive impairment and to delineate the relationship between pain and behavioral and psychological symptoms of dementia.Patients and methodsThe research was conducted in 2 nursing home facilities in Wielkopolska, Poland. The analyzed group consisted of 96 residents (78 female) with moderate and severe cognitive impairment in whom pain was assessed with the Abbey Pain Scale (APS) and agitation with the Cohen–Mansfield Agitation Inventory (CMAI). Thereafter, medical files related to drug prescriptions were analyzed.ResultsAnalgesics were consumed by 33 individuals (34%); 24 (25%) received regular pain treatment and 7 individuals (7%) – as when needed pain treatment. A relationship was found between the APS and CMAI (r=0.45, p<0.0001). Subjects with a higher CMAI received sedative drugs more frequently (p<0.001), and despite having a higher APS (p=0.001), this did not correlate with higher analgesia.ConclusionOur study suggests that pain can be an important underlying cause of behavioral disturbances in older subjects with dementia. In order to reduce their frequency and to avoid excessive usage of sedatives, proper pain assessment and management are essential.

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“…Mini-Mental State Examination (MMSE) scores ( 22 ) were available in 65% of the charts and the mean score in those patients was 14.21 (± 5.50). Severity of agitation (e.g., Cohen-Mansfield Agitation Inventory) ( 23 ) was not systematically documented in the charts. Other demographic and clinical characteristics are listed in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

Management of Agitation in Dementia and Effects on Inpatient Length of Stay

Silverstone-Simard

Nassim

et al. 2021

Can Geri J

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Background Agitation associated with dementia impacts delivery of medical care and is a major reason for institutionalization in dementia patients. This study examines the association of medication use and other clinical factors with patients’ ‘dischargeability’ (i.e., amount of time until a patient is considered dischargeable from an inpatient unit). Methods This study was a retrospective chart review examining 200 patients with dementia and agitation, hospitalized at a Canadian acute care geriatric ward between November 2007 and November 2018. The main outcome measure was time until a patient was deemed dischargeable. Univariate linear regression analyses, followed by multiple linear regression analyses, were used. Results Risperidone and quetiapine were the most commonly prescribed medications, but were not associated with time until dischargeable. Olanzapine (40.9 vs. 16.2 days until dischargeable, β = 0.23, p = .001), regular benzodiazepine (32.7 vs. 16.5 days until dischargeable, β = 0.15, p = .027), and as-needed (‘PRN’) benzodiazepine use (31.7 vs. 15.9 days until dischargeable, β =0.19, p = .006) were independently associated with prolonging time until dischargeable. Conclusions Olanzapine, benzodiazepine, and PRN benzodiazepine use were associated with longer time until patients with dementia and agitation were considered ready for discharge. This raises the question as to whether the risks of these medications outweigh the benefits in a hospital setting.

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Psychometric evaluation of the Cohen‐Mansfield Agitation Inventory in an acute general hospital setting

Cited by 15 publications

References 38 publications

Pain and delirium in people with dementia in the acute general hospital setting

Pain and delirium in people with dementia in the acute general hospital setting

Pain as a challenge in nursing home residents with behavioral and psychological symptoms of dementia

Management of Agitation in Dementia and Effects on Inpatient Length of Stay

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