Jiska Cohen-Mansfield

Agitated Behaviors in the Elderly: I. A Conceptual Review

Agitation is a significant problem for the elderly, their families, and their caretakers. Although much of the literature on agitation is pharmacologic in nature, several papers demonstrate demographic and environmental approaches to the problem. The literature review accentuates the gaps in both assessment and knowledge of the phenomenon. A conceptual framework and a rigorous methodology need to be developed for studying agitation. On these bases, research could explore the manifestations of agitation and the frequency of occurrence, predisposing factors for agitation, precipitating factors which trigger agitation, consequences of agitation for the elderly and for their caretakers, and the efficacy of alternative interventions. This paper proposes a definition of agitation and develops an initial conceptual framework in which to examine it.

Dementia prevention, intervention, and care

Acting now on dementia prevention, intervention, and care will vastly improve living and dying for individuals with dementia and their families, and in doing so, will transform the future for society. Dementia is the greatest global challenge for health and social care in the 21st century. It occurs mainly in people older than 65 years, so increases in numbers and costs are driven, worldwide, by increased longevity resulting from the welcome reduction in people dying prematurely. The Lancet Commission on Dementia Prevention, Intervention, and Care met to consolidate the huge strides that have been made and the emerging knowledge as to what we should do to prevent and manage dementia. Globally, about 47 million people were living with dementia in 2015, and this number is projected to triple by 2050. Dementia affects the individuals with the condition, who gradually lose their abilities, as well as their relatives and other supporters, who have to cope with seeing a family member or friend become ill and decline, while responding to their needs, such as increasing dependency and changes in behaviour. Additionally, it affects the wider society because people with dementia also require health and social care. The 2015 global cost of dementia was estimated to be US

Screaming in Nursing Home Residents

818 billion, and this figure will continue to increase as the number of people with dementia rises. Nearly 85% of costs are related to family and social, rather than medical, care. It might be that new medical care in the future, including public health measures, could replace and possibly reduce some of this cost.

Physical restraints and agitation in nursing home residents.

This article reports the results of two studies of screaming in the nursing home. The first was a survey study of 408 nursing home residents, which revealed that 25% of the residents screamed at least four times a week. Screaming was associated with cognitive impairment, depressed affect, social networks of poor quality, and severe impairment in the performance of activities of daily living. The second study was an in‐depth observational study of five residents who screamed frequently. Residents screamed more often when they were alone in their rooms during the evening hours, suggesting that screaming may arise as a response to social isolation.

Agitation in elderly persons: an integrative report of findings in a nursing home.

An observational study was performed to determine whether the use of physical restraints in agitated nursing home residents leads to decreased or increased agitation. Results indicate that restraint use does not decrease agitation in nursing home residents. Residents exhibited either the same amount or more agitated behaviors when they were restrained than when they were not restrained, suggesting that the act of restraining may itself contribute to manifestations of agitation. The implications of the use of restraints in agitated nursing home residents are discussed, with particular reference to the prevention of falls.

Dementia and Agitation in Nursing Home Residents: How Are They Related?

Agitated behaviors in the nursing home pose a major problem for caregivers. Our data showed that the three syndromes of agitation--aggressive behaviors, physically nonaggressive behaviors, and verbally agitated behaviors--are differentially related to medical and psychosocial variables. Physically nonaggressive behaviors may be adaptive for a resident who presents a deteriorated stage of dementia, since these behaviors offer stimulation and exercise. Verbally agitated behaviors may be a form of help-seeking behavior for residents with physical disease and depressed affect. Aggressive behaviors are those least understood, although these behaviors correlate with advanced stages of dementia and with poor interpersonal relationships. These findings should be a basis for further studies, with the ultimate goal being improved care for agitated elderly persons.

Assessment and treatment of pain in people with dementia

The link between agitated behaviors and cognitive functioning in 408 nursing home residents was examined. Results showed that cognitively impaired residents manifested aggressive behaviors (e.g., cursing, hitting) and physically nonaggressive behaviors (e.g., pacing). The highest levels of physically nonaggressive behaviors were manifested by those residents who presented intermediate levels of impairment in their performance of activities of daily living. Cognitively intact residents exhibited verbally agitated behaviors (e.g., complaining). These findings have important implications for caregivers of agitated nursing home residents.

Therapeutic robocat for nursing home residents with dementia: Preliminary inquiry

Many elderly people experience pain and regularly take analgesic medication. Pain is also frequent in people with dementia, particularly those with severe disease. As no robust clinical guidelines are available for the treatment of pain in the context of dementia, the risk of inadequate treatment in individuals with this condition is high. Furthermore, our understanding of the aetiology of pain and the potential role of dementia-associated neuropathology in pain is limited. These issues are important in the clinical management of individuals with dementia, as untreated pain is a major contributor to reduced quality of life and disability, and can lead to increased behavioural and psychological symptoms. Assessment scales to identify pain in people with dementia have been highlighted in recent studies, but there is little evidence for consistency between these tools. Numerous studies have evaluated various approaches for the treatment of pain, including stepped-care protocols and/or administration of paracetamol and opioid medications. In this Review, we summarize the best-available evidence regarding the aetiology, assessment and treatment of pain in people with dementia. Further validation of assessment tools and large-scale trials of treatment approaches in people with dementia are needed to improve clinical guidance for the treatment of pain in these individuals.

Self-identity in older persons suffering from dementia : preliminary results

Traditional pet therapy enhances individual wellbeing. However, there are situations where a substitute artificial companion (i.e., robotic pet) may serve as a better alternative because of insufficient available resources to care for a real pet, allergic responses to pets, or other difficulties. This pilot study, which compared the benefits of a robotic cat and a plush toy cat as interventions for elderly persons with dementia, was conducted at a special care unit of a large, not-for-profit nursing home. Various aspects of a persons engagement and affect were assessed through direct observations. Though not identical, similar trends were seen for the two cats. Interacting with the cats was linked with decreased agitation and increased pleasure and interest. The study is intended to pave the way for future research on robotherapy with nursing home residents.

An observational study of agitation in agitated nursing home residents.

In this study, we explored the role-identity of nursing home residents suffering from dementia, as well as the potential for utilizing their enduring sense of self-identity for enhancing their quality of life. Four types of role-identity were explored: professional, family-role, leisure activities, and personal attributes. The methodology included structured interviews and a case study. Participants for the interviews were 38 residents of two nursing homes in Israel. Residents, relatives, and staff members were interviewed to provide information about past roles and the degree to which those roles are maintained in the present, and about strategies for bolstering the sense of self-identity. A large range of roles were identified. All role identities deteriorated significantly, with family roles retaining the greatest prominence in the present. However, much heterogeneity was manifested in all roles. Both staff members and relatives felt that a sense of identity in residents could be enhanced in most of the residents, which would exert a beneficial effect on their well-being. Caregiving respondents anticipated that this improvement would be substantial for about half of the residents. The case study illustrates how self-identity can change throughout dementia, and how it can be utilized to improve quality of life.