Nursing Home Resident Agitation: Predictors and Interventions

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 nursing home residents suffering from dementia were selected. 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 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.