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Nursing Home Resident Agitation: Predictors and Interventions
To critically review selected articles investigating and discussing predictors of nursing home resident agitation, and recommended interventions.
Burgio et al., (2007, p. 642) provides a working definition of nursing home resident agitation "… as verbal, vocal, and motor activities that are repetitive, outside of social standards, and considered inappropriate by staff." Agitation can often involve physical and/or verbal aggression, which can increase the risk of harm to residents and staff, disrupt activities, divert precious resources, and lead to staff burnout and high turnover.
Critical literature review.
Medical literature databases were searched using the keywords 'agitation, nursing home, and demetia' and a limited number of articles published within the last 10 years were selected for review.
Inclusion Criteria. Articles investigating and/or reviewing the etiology of agitation in geriatric nursing home residents suffering from dementia were selected, as were articles recommending interventions.
Exclusion Criteria. Only those articles involving agitation and geriatric...
Discussions and research involving younger and healthier patients were excluded. Articles older than 10 years were excluded. The number of articles selected was limited to between 5 and 10.
Aims. Understanding the etiology of nursing home resident agitation, and developing effective interventions, could significantly improve the quality of life for both residents and staff.
The following questions were addressed during the review process:
What were the goals of the research?
What type of study?
What demographic was studied?
If there were controls, how did they differ from the study population?
What was the experimental strategy?
What were the conclusions?
Were they significant?
What recommendations were made?
Results
The two cohort studies reviewed here used computer assisted behavioral observation systems (CABOS) to identify predictors of agitation in geriatric nursing home residents suffering from dementia. One study monitored 78 nursing home residents (Burgio, Park, Hardin, and…
Results
The two cohort studies reviewed here used computer assisted behavioral observation systems (CABOS) to identify predictors of agitation in geriatric nursing home residents suffering from dementia. One study monitored 78 nursing home residents (Burgio, Park, Hardin, and Sun, 2007, mean age = 82.2) and the other 123 (Vance, Burgio, Roth, Stevens, Fairchild, and Yurick, 2003, mean age = 82.3), but neither study used a normal control population. The experimental strategy involved assessing various physical and mental criteria periodically to determine if they predicted agitation behaviors within this population. Both studies found a statistically significant correlation between cognitive functioning and agitation (p < 0.01). Burgio et al., (2007) was unable to find a significant correlation between agitation and gender, age, and daily activities, but the earlier study (Vance et al., 2003) reported significant, but weak correlations between agitation and gender (r = 0.21), visual impairment (r = -0.21), and hearing impairment (r = 0.42). The inverse relationship between visual impairment was attributed to residents being unable to notice staff walking by, which can otherwise trigger outbursts. Only in the latter study was retrospective nursing staff reports able to predict agitation behavior based on assessments of cognitive functioning, suggesting variability in the ability of nursing home staff to correctly assess resident cognitive status. The authors of both studies recommend the use of CABOS-like systems of measurement to determine activity levels for future studies, because staff reports aren't a reliable predictor of agitation behavior.
For more than 60 years it has been recognized that agitation worsens in Alzheimer's patients in late afternoon and early evening, a phenomenon accordingly termed Sundowning Syndrome (reviewed by Bachman & Rabins, 2006). Volicer et al. (2001) used body temperature to track circadian rhythms in inpatient Alzheimer patients with a mean age of 71 and suffering from different levels of dementia. It was discovered that individuals within the
Myra's case is just one instance of many that a mental health nurse encounters on a regular schedule. Nursing is best practiced when it follows the intentions of its founder Florence Nightingale who urged that nursing should be a practice that should literally provide for and care for the patient. Nursing, in other words, should be purely patient-centered. This caring extends to all aspects not just to the illness so that
music therapy reduce the level of sundowning agitation of the elderly dementia in-Patients in comparison to standard care only or to no music therapy? Sundowning is a phenomenon that occurs within elderly people showing middle stages of dementia. Many treatments have been studied and offered to help reduce the level of sundowning agitation in these elderly patients. Some have used standard care only while other facilities se music therapy. Music
126). Although there are an increasing number of elderly in the United States today with many more expected in the future, the study of elder abuse is of fairly recent origin. During the last three decades of the 20th century, following the "discovery" of child abuse and domestic violence, scholars and professionals started taking an active interest in the subject of elder abuse. This increased attention from the academic