Very frequent physical aggression and vocalizations in nursing home residents with dementia

Abstract

Objectives: We investigated the 2-week prevalence and correlates of very frequent physical aggression (PA) and vocalizations in nursing home (NH)-residents with dementia. Method/Design: This cross-sectional study used combined data of 2074 NH-residents from four studies, collected from 119 dementia special care units in 26 Dutch NH. Very frequent PA was defined as scoring 6 or 7 on the items 'hitting', pushing', 'biting' and 'kicking' of the Cohen Mansfield Agitation Inventory; very frequent vocalizations as scoring 6 or 7 on 'screaming' and 'making strange noises'. We compared NH-residents with very frequent PA or vocalizations with residents with less frequent PA or vocalizations, assessing correlates using univariate and multivariate multilevel logistic regression analyses. Results: We found a 2-week prevalence of 2.2% (95% confidence interval (CI): 1.63-2.89) of very frequent PA and 11.5% of very frequent vocalizations (95% CI: 10.23-12.98). Very frequent PA was only associated with apathy (odds ratio (OR)¼1.93, 95% CI: 1.04-3.61). Correlates of very frequent vocalizations were age (OR ¼ 0.97, 95% CI: 0.951-0.998), dementia severity (overall p-value 0.020), antipsychotic drug use (OR ¼ 1.56, 95% CI: 1.08-2.26), antiepileptic drug use (OR ¼ 2.75, 95% CI: 1.34-5.68) and euphoria (OR ¼ 2.01, 95% CI: 1.22-3.31). Conclusion: Characteristics of NH-residents with very frequent PA or very frequent vocalizations differ from those of NH-residents with less frequent PA or vocalizations. Frontal lobe damage, boredom, pain and/or external factors may explain several of the found associations, but further research is necessary. Our findings may contribute to better care for these residents and thereby to improving their quality of life.

Losing hope or keep searching for a golden solution: an in-depth exploration of experiences with extreme challenging behavior in nursing home residents with dementia

“…In their seven-tiered model of the severity and prevalence of challenging behavior, Brodaty et al categorise extreme challenging behavior as Tier 7, with an estimated prevalence described as rare [4]. In our WAALBED (WAAL-Behavior-in-Dementia)-III study, similar two-week prevalence rates of 7.4% of very frequent agitation, 2.2% of very frequent physical aggression and 11.5% of very frequent vocalizations were found [5,6]. Previous studies have shown that challenging behavior has a great influence on the residents and their environment (relatives, nursing home staff and other residents), especially in case of aggression [8][9][10].…”

“…This explorative, qualitative study was performed as a distinct part of the WAALBED-III study that focused on nursing home residents with dementia and extreme challenging behavior [5,6,14]. Because of the lack of a theoretical frame to explain why situations of extreme challenging behavior in nursing home residents with dementia are experienced as an impasse, we decided to apply qualitative methods in this study.…”

“…In nursing homes, over 80% of residents with dementia show challenging behavior, which encompass a broad spectrum of behaviors and become more severe as the dementia progresses [1][2][3]. A minority of cases consist of extreme challenging behavior, which is severe and/ or occurs frequently [4][5][6][7]. In their seven-tiered model of the severity and prevalence of challenging behavior, Brodaty et al categorise extreme challenging behavior as Tier 7, with an estimated prevalence described as rare [4].…”

Care home residents with dementia: Prevalence, incidence, and associations with sleep disturbance in an English cohort study

“…This is in line with multiple studies in residents with dementia measuring sleep disturbances on the NPI sleep item. 14,43,44 In our qualitative study, 15 staff described resident agitation as both a cause and consequence of sleep disturbances, as agitation may be why residents sleep badly but they may be agitated for other reasons, such as pain, 45 which could also contribute to poor sleep. 46 Agitation and quality of life are highly correlated in the MARQUE cohort study 16 and a previous study in Japanese care home residents found sleep disturbances on the NPI sleep item associated with lower quality of life.…”

Reliability and Validity of a Chinese Version of the Cohen–Mansfield Agitation Inventory-Short Form in Assessing Agitated Behavior

“…Terms such as aggressive, disturbing, problematic, disruptive behaviors, and restlessness have been used in other research on this topic [ 8 , 9 ]. Older age, functional impairment [ 10 ], and declining cognitive function influence and aggravate agitated behaviors [ 11 , 12 ].…”