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      Clinical Interventions in Aging (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on prevention and treatment of diseases in people over 65 years of age. Sign up for email alerts here.

      36,334 Monthly downloads/views I 3.829 Impact Factor I 7.4 CiteScore I 1.83 Source Normalized Impact per Paper (SNIP) I 1.044 Scimago Journal & Country Rank (SJR)

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      Agitated behaviors among elderly people with dementia living in their home in Taiwan

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          Abstract

          Background/aims

          Limited research has been conducted on agitated behavior in Taiwan and dementia among community-dwelling elderly. Therefore, this study focused on community elderly with dementia and a factor analysis of an inventory of their agitated behaviors was conducted.

          Patients and methods

          Participants (N=221) completed the Chinese Cohen-Mansfield Agitation Inventory, community form. Item analysis and exploratory factor analysis assessed reliability, validity, and the underlying factor structure.

          Results

          Five factors were extracted and accounted for 44.53% of the total variance. This study classified agitated behaviors into 5 main subtypes: physically agitated behaviors, destructive behaviors, verbally agitated behaviors, handling things behavior, and aggressive behaviors.

          Conclusion

          The results indicate that differences in the agitated behavior of elderly with dementia exist with respect to cultural background and setting. This novel research and its findings serve as a reference for assessing the agitated behaviors of elderly with dementia living in their homes. Applications may exist for other countries with Chinese/Taiwanese populations.

          Most cited references17

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          Grouping of behavioural and psychological symptoms of dementia†

          Rianne M. van der Linde, Tom Dening, Fiona Matthews … (2013)
          Objective A wide range of behavioural and psychological symptoms (BPSD) are common in dementia, and it has been suggested that groups of correlated symptoms should be studied together. Here, we describe the groups of BPSD that have been identified in the literature and how they have been used to study associations, burden, treatment and underlying biology. Methods The literature database PubMed was searched for articles that identified clusters or factors of BPSD or used previously defined symptom groups. Results Sixty-two studies were included. Generally, the following symptom groups were suggested: affective symptoms, including depression and anxiety; psychosis, including delusions and hallucinations; hyperactivity, including irritability and aggression; and euphoria. Symptoms that did not show consistent results include apathy, eating disturbances, night-time behaviour disturbances, disinhibition and aberrant motor behaviour. Symptom groups differed in their associations, treatment and biology. Conclusions Studies investigating symptom groups show relatively consistent results. Studying symptom groups allows similar symptoms to be studied together, which might strengthen results and may point to differences in their aetiology and treatment. However, a large amount of the individual variability of the symptoms could not be explained by the factors, and authors should carefully address their research question and hypotheses to decide if symptoms should be studied in groups or individually. Clinicians need to consider each symptom in its own right and also to be aware of the interrelations between them when assessing patients and developing strategies for treatment. © 2013 The Authors. International Journal of Geriatric Psychiatry by John Wiley & Sons, Ltd.
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            Olanzapine treatment of psychotic and behavioral symptoms in patients with Alzheimer disease in nursing care facilities: a double-blind, randomized, placebo-controlled trial. The HGEU Study Group.

            Howard Clark, Steven Street, Michael D. Feldman … (2000)
            Patients with Alzheimer disease (AD) commonly exhibit psychosis and behavioral disturbances that impair patient functioning, create caregiver distress, and lead to institutionalization. This study was conducted to assess the efficacy and safety of olanzapine in treating psychosis and/or agitation/aggression in patients with AD. A multicenter, double-blind, placebo-controlled, 6-week study was conducted in 206 elderly US nursing home residents with AD who exhibited psychotic and/or behavioral symptoms. Patients were randomly assigned to placebo or a fixed dose of 5, 10, or 15 mg/d of olanzapine. The primary efficacy measure was the sum of the Agitation/Aggression, Hallucinations, and Delusions items (Core Total) of the Neuropsychiatric Inventory-Nursing Home version. Low-dose olanzapine (5 and 10 mg/d) produced significant improvement compared with placebo on the Core Total (-7.6 vs -3.7 [P<.001] and -6.1 vs -3. 7 [P =.006], respectively). Core Total improvement with olanzapine, 15 mg/d, was not significantly greater than placebo. The Occupational Disruptiveness score, reflecting the impact of patients' psychosis and behavioral disturbances on the caregiver, was significantly reduced in the 5-mg/d olanzapine group compared with placebo (-2.7 vs -1.5; P =.008). Somnolence was significantly more common among patients receiving olanzapine (25.0%-35.8%), and gait disturbance occurred in those receiving 5 or 15 mg/d (19.6% and 17.0%, respectively). No significant cognitive impairment, increase in extrapyramidal symptoms, or central anticholinergic effects were found at any olanzapine dose relative to placebo. Low-dose olanzapine (5 and 10 mg/d) was significantly superior to placebo and well tolerated in treating agitation/aggression and psychosis in this population of patients with AD.
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              Factor analysis of the Cohen-Mansfield Agitation Inventory in three large samples of nursing home patients with dementia and behavioral disturbance.

              Jonathan Rabinowitz, Michael Davidson, Peter Paul De Deyn … (2005)
              Limited work has addressed the construct validity of the Cohen-Mansfield Agitation Inventory (CMAI) in nursing home patients. The authors tested the CMAI factor structure by use of data from three samples of nursing home patients categorized a priori as having at least mild behavioral and psychological symptoms of dementia. CMAI data were from the baseline assessment of three randomized, placebo-controlled trials of risperidone for treating elderly nursing home patients. Exploratory factor analyses were conducted on two trials (N = 304; N = 344), and the results of these exploratory factor analyses were then tested with confirmatory factor analysis by use of data from a third trial (N = 617). Principal-components analysis suggested the presence of four factors: 1) Aggressive Behavior (hitting, kicking, scratching, biting, pushing, grabbing, throwing things, cursing or verbal aggression, spitting, tearing things/destroying property, hurting self or others, screaming); 2) Physically Non-Aggressive Behavior (pacing, trying to get to a different place, general restlessness, inappropriate dressing or disrobing, handling things inappropriately, performing repetitious mannerisms); 3) Verbally Agitated Behavior (complaining, constant requests for attention, repetitive questions, negativism); and 4) Hiding and Hoarding. Confirmatory factor analysis indicated that the four-factor solution was a reasonable fit to the data. Four factors emerged on the CMAI in nursing home patients with behavioral and psychological symptoms of dementia. The results obtained converge reasonably with previous publications concerning the factor structure of the CMAI, which, taken together, suggest a fairly robust factor structure for the instrument.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Interv Aging
                Journal ID (iso-abbrev): Clin Interv Aging
                Journal ID (publisher-id): Clinical Interventions in Aging
                Title: Clinical Interventions in Aging
                Publisher: Dove Medical Press
                ISSN (Print): 1176-9092
                ISSN (Electronic): 1178-1998
                Publication date Collection: 2018
                Publication date (Electronic): 29 June 2018
                Volume: 13
                Pages: 1193-1199
                Affiliations
                [1 ]Department of Gerontological Care and Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan, yeaing@ 123456mail.cgu.edu.tw
                [2 ]Nursing Department, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
                [3 ]School of Nursing, College of Medicine & Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan, yeaing@ 123456mail.cgu.edu.tw
                [4 ]Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, yeaing@ 123456mail.cgu.edu.tw
                [5 ]Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, yeaing@ 123456mail.cgu.edu.tw
                [6 ]Chang Gung Dementia Center, Department of Neurology, Chang Gung University and Memorial Hospital, Taoyuan, Taiwan
                Author notes
                Correspondence: Yea-Ing L Shyu, School of Nursing, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Taoyuan 333, Taiwan, Tel +886 3 211 8800 ext 5275, Fax +886 3 211 8400 Email yeaing@ 123456mail.cgu.edu.tw
                Article
                Publisher ID: cia-13-1193
                DOI: 10.2147/CIA.S160243
                PMC ID: 6029592
                SO-VID: f6bb1968-eadb-4018-9cf0-03f875052a57
                Copyright © © 2018 Huang et al. This work is published and licensed by Dove Medical Press Limited
                License:

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Subject: Original Research

                ScienceOpen disciplines: Health & Social care
                Keywords: agitation,aggressive behavior,behavioral problem,caregiver,factor analysis,dementia
                Data availability:
                ScienceOpen disciplines: Health & Social care
                Keywords: agitation, aggressive behavior, behavioral problem, caregiver, factor analysis, dementia

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