Objectives: Most individuals with dementia develop significant behavioural problems. Restlessness is a behavioural symptom frequently endorsed by caregivers as distressing, yet is variably defined and measured. Lack of conceptual and operational clarity hinders an understanding of this common behavioural type, its prevalence, and development of effective interventions. The authors advance a systematic definition and understanding of restlessness from which to enhance reporting and intervention development.
Method: The literature for existing definitions and measures of restlessness, is reviewed and common elements across existing definitions are identified. Fit with relevant theoretical frameworks are assessed, and the relationship between restlessness and other behavioural symptoms in a data set of 272 community-dwelling persons with dementia are explored.
Results: Twenty-five scales assessing restlessness were identified. Shared components included motor/neurological, psychiatric, and needs-based features. Exploratory analyses suggest that restlessness may co-occur primarily with argumentation, anxiety, waking the caregiver, delusions/hallucinations, and wandering. The authors propose that restlessness consists of three key attributes: diffuse motor activity or motion subject to limited control, non-productive or disorganised behavior, and subjective distress. Restlessness should be differentiated from and not confused with wandering or elopement, pharmacological side effects, a (non-dementia) mental or movement disorder, or behaviours occurring in the context of a delirium or at end-of-life.
Conclusion: Restlessness appears to denote a distinct set of behaviours that have overlapping but non-equivalent features with other behavioural symptoms. The authors propose that it reflects a complex behaviour involving three key characteristics. Understanding its specific manifestations and which components are present can enhance tailoring interventions to specific contexts of this multicomponent behavioural type.
(Edited publisher abstract)
Objectives: Most individuals with dementia develop significant behavioural problems. Restlessness is a behavioural symptom frequently endorsed by caregivers as distressing, yet is variably defined and measured. Lack of conceptual and operational clarity hinders an understanding of this common behavioural type, its prevalence, and development of effective interventions. The authors advance a systematic definition and understanding of restlessness from which to enhance reporting and intervention development.
Method: The literature for existing definitions and measures of restlessness, is reviewed and common elements across existing definitions are identified. Fit with relevant theoretical frameworks are assessed, and the relationship between restlessness and other behavioural symptoms in a data set of 272 community-dwelling persons with dementia are explored.
Results: Twenty-five scales assessing restlessness were identified. Shared components included motor/neurological, psychiatric, and needs-based features. Exploratory analyses suggest that restlessness may co-occur primarily with argumentation, anxiety, waking the caregiver, delusions/hallucinations, and wandering. The authors propose that restlessness consists of three key attributes: diffuse motor activity or motion subject to limited control, non-productive or disorganised behavior, and subjective distress. Restlessness should be differentiated from and not confused with wandering or elopement, pharmacological side effects, a (non-dementia) mental or movement disorder, or behaviours occurring in the context of a delirium or at end-of-life.
Conclusion: Restlessness appears to denote a distinct set of behaviours that have overlapping but non-equivalent features with other behavioural symptoms. The authors propose that it reflects a complex behaviour involving three key characteristics. Understanding its specific manifestations and which components are present can enhance tailoring interventions to specific contexts of this multicomponent behavioural type.
(Edited publisher abstract)
International Journal of Geriatric Psychiatry, 31(9), 2016, pp.1056-1063.
Publisher:
Wiley
Background: Previous research shows that nonpharmacological strategies may effectively manage behavioural symptoms (agitation, wandering) in persons with dementia and improve caregiver wellbeing. However, strategies depend upon caregivers for their implementation. This study examines the impact of caregiver readiness to use nonpharmacological strategies on treatment outcomes.
Methods: Data were
(Edited publisher abstract)
Background: Previous research shows that nonpharmacological strategies may effectively manage behavioural symptoms (agitation, wandering) in persons with dementia and improve caregiver wellbeing. However, strategies depend upon caregivers for their implementation. This study examines the impact of caregiver readiness to use nonpharmacological strategies on treatment outcomes.
Methods: Data were from a randomized trial involving 110 family caregivers in the treatment group which received nonpharmacologic strategies for managing behavioural symptoms. Interventionists rated caregiver readiness to use nonpharmacologic strategies as pre-action (precontemplation, contemplation, preparation) or action at treatment initiation and conclusion. Caregivers in pre-action and action stages by treatment conclusion (16 weeks) were compared on proximal (frequency of, and caregiver upset and confidence with targeted behaviours) and more distal (caregiver burden and wellbeing) outcomes at 16 and 24-week follow-ups.
Results: By treatment conclusion, 28.2% (n = 31) and 71.8% (n = 79) of caregivers were rated at pre-action and action respectively. Means for proximal outcomes differed between the groups at 16 and 24 weeks; those at action showed greater improvement on all proximal and distal outcomes. Hierarchical regressions showed significant relationships of readiness to targeted outcomes. By 24 weeks, caregiver readiness predicted lower frequency estimates of targeted behaviours and higher confidence. Readiness was not a significant predictor of caregiver burden and wellbeing at 16 or 24 weeks.
Conclusion: By treatment conclusion, >25% of participants were not activated to use nonpharmacologic strategies. Activated caregivers reported greater decline in distressing behavioural symptoms, and more confidence than non-activated participants. Activation is needed to impact behavioural management but not other caregiver outcomes.
(Edited publisher abstract)
CHOI Scott Seung W., BUDHATHOKI Chakra, GITLIN Laura N.
Journal article citation:
International Journal of Geriatric Psychiatry, 34(7), 2019, pp.966-973.
Publisher:
Wiley
Objective: The relationship of specific dementia‐related behaviours to caregiver depression and moderating factors is unclear. This study examined the role of rejection of care, aggression, and agitation to caregiver depression and if social support and mastery independently moderated associations. Methods: The method used was a cross‐sectional, secondary analysis using baseline data from two community‐based clinical trials. This study examined frequency of occurrence of presenting behaviours and their combinations in persons with dementia. Multiple logistic regression analyses examined associations between nonoverlapping behavioural clusters (agitation alone, agitation + rejection, agitation + aggression, and agitation + rejection + aggression) and caregiver depression. Multiple logistic regression with interaction terms was also used to investigate whether social support or caregiver mastery moderated the relationship between behavioural symptom clusters and caregiver depression. Results: Three of four symptom clusters (all three behaviours [adjusted odds ratio (AOR) = 2.22; 95% CI, 1.02‐4.83], agitation + rejection of care [AOR = 2.55; 95% CI, 1.06‐6.13], and agitation + aggression [AOR = 2.63; 95% CI, 1.17‐5.89]) had a positive association with caregiver depression, whereas agitation alone was not significantly associated with caregiver depression. Neither social support nor mastery significantly moderated the relationship between these three behavioural clusters and caregiver depression. Conclusion: Caregiver depression was associated with different combinations of behaviours but not with agitation
(Edited publisher abstract)
Objective: The relationship of specific dementia‐related behaviours to caregiver depression and moderating factors is unclear. This study examined the role of rejection of care, aggression, and agitation to caregiver depression and if social support and mastery independently moderated associations. Methods: The method used was a cross‐sectional, secondary analysis using baseline data from two community‐based clinical trials. This study examined frequency of occurrence of presenting behaviours and their combinations in persons with dementia. Multiple logistic regression analyses examined associations between nonoverlapping behavioural clusters (agitation alone, agitation + rejection, agitation + aggression, and agitation + rejection + aggression) and caregiver depression. Multiple logistic regression with interaction terms was also used to investigate whether social support or caregiver mastery moderated the relationship between behavioural symptom clusters and caregiver depression. Results: Three of four symptom clusters (all three behaviours [adjusted odds ratio (AOR) = 2.22; 95% CI, 1.02‐4.83], agitation + rejection of care [AOR = 2.55; 95% CI, 1.06‐6.13], and agitation + aggression [AOR = 2.63; 95% CI, 1.17‐5.89]) had a positive association with caregiver depression, whereas agitation alone was not significantly associated with caregiver depression. Neither social support nor mastery significantly moderated the relationship between these three behavioural clusters and caregiver depression. Conclusion: Caregiver depression was associated with different combinations of behaviours but not with agitation alone. These results have implications for intervention development and identifying caregivers at risk for depression. Level of social support and mastery does not appear to moderate impact on caregiver depression.
(Edited publisher abstract)
Subject terms:
dementia, outcomes, carers, aggression, depression, agitation, behaviour, service uptake;