International Journal of Geriatric Psychiatry, 22(9), September 2007, pp.916-921.
Publisher:
Wiley
Although behavioural and psychological symptoms of dementia (BPSD) increase with increasing dementia severity, and institutionalization of an individual with dementia is often caused by behavioural symptoms, relatively few studies have explored the prevalence of BPSD in nursing homes. This study has taken place in dementia wards in four Norwegian nursing homes. To measure agitation in residents with dementia we used the Cohen-Mansfield Agitation Inventory (CMAI), consisting of 29 agitation items. Dementia stage was measured by Functional Assessment Staging (FAST). Two hundred and eleven patients (71% female) were included in the study: mean (SD) age 85.5 (8.4), FAST 4.7 (2.1), CMAI total sumscore 39.5 (12.6). Dementia was present in 167 (79%) subjects. Among those with dementia, weekly occurrence of at least one CMAI item (i.e. a score of 3 or higher) occurred in 75.4% (95% CI 68.4-81.4). Six of the items occurred at least weekly in 20% of the residents with dementia, and 11 of the items, including physical aggression, occurred in less than 5% of the residents. Agitation was associated with more severe dementia (p = 0.001), but not with age and gender. Symptoms of agitation were common, but may
Although behavioural and psychological symptoms of dementia (BPSD) increase with increasing dementia severity, and institutionalization of an individual with dementia is often caused by behavioural symptoms, relatively few studies have explored the prevalence of BPSD in nursing homes. This study has taken place in dementia wards in four Norwegian nursing homes. To measure agitation in residents with dementia we used the Cohen-Mansfield Agitation Inventory (CMAI), consisting of 29 agitation items. Dementia stage was measured by Functional Assessment Staging (FAST). Two hundred and eleven patients (71% female) were included in the study: mean (SD) age 85.5 (8.4), FAST 4.7 (2.1), CMAI total sumscore 39.5 (12.6). Dementia was present in 167 (79%) subjects. Among those with dementia, weekly occurrence of at least one CMAI item (i.e. a score of 3 or higher) occurred in 75.4% (95% CI 68.4-81.4). Six of the items occurred at least weekly in 20% of the residents with dementia, and 11 of the items, including physical aggression, occurred in less than 5% of the residents. Agitation was associated with more severe dementia (p = 0.001), but not with age and gender. Symptoms of agitation were common, but may nevertheless be lower compared to findings in other geographical areas. Further studies are warranted to test this hypothesis, and if confirmed, to explore possible causes for such differences.
International Journal of Geriatric Psychiatry, 22(5), May 2007, pp.405-410.
Publisher:
Wiley
Agitated behaviours among persons with dementia are distressing to both patients and their caregivers. As pharmacological interventions may be limited by their potentially adverse effects, the use of complementary therapies for treatment of agitation has become more popular and aromatherapy is the fastest growing one. This study investigates the effectiveness of lavandula angustifolia (lavender) the Chinese versions of Cohen-Mansfield Agitation Inventory (CCMAI) and Neuropsychiatric Inventory (CNPI) The mean CCMAI total scores decreased from 24.68 to 17.77. The CNPI scores changed from 63.17 to 58.77 after receiving Treatment A (Lavandula Angustifolia). There were no period and sequential effects noted. In summary, lavender is effective as an adjunctive therapy in alleviating agitated behaviours
Agitated behaviours among persons with dementia are distressing to both patients and their caregivers. As pharmacological interventions may be limited by their potentially adverse effects, the use of complementary therapies for treatment of agitation has become more popular and aromatherapy is the fastest growing one. This study investigates the effectiveness of lavandula angustifolia (lavender) in treating agitated behaviours of demented people in Hong Kong. It was a cross-over randomized trial. Seventy Chinese older adults with dementia were recruited; half were randomly assigned to the active group (lavender inhalation) for three weeks and then switched to control group (sunflower inhalation) for another three weeks; the other half did the opposite. Clinical response was evaluated using the Chinese versions of Cohen-Mansfield Agitation Inventory (CCMAI) and Neuropsychiatric Inventory (CNPI) The mean CCMAI total scores decreased from 24.68 to 17.77. The CNPI scores changed from 63.17 to 58.77 after receiving Treatment A (Lavandula Angustifolia). There were no period and sequential effects noted. In summary, lavender is effective as an adjunctive therapy in alleviating agitated behaviours in Chinese patients with dementia. In a patient population particularly vulnerable to side effects of psychotropic medications, aromatherapy using lavender may offer an alternative option.
This American study explored whether adult day service (ADS) use was associated with reductions in behavioural and psychological symptoms of dementia (BPSD) in individuals with dementia. A quasi-experimental design was used to compare a group of 133 persons with dementia (PWDs) who initially enrolled in an ADS program to a control group not using these services (n = 68). Caregivers used a 24-hour log on multiple, consecutive days to report on five domains of BPSD. Growth-mixture modelling techniques were used to model change in the BPSD domains over a 2-month period as well as to handle the preponderance of zeros that were inherent in the data. Results showed a relationship between ADS use and caregivers' report of fewer night-time sleep-related problems for their PWDs. Trends for other domains, specifically depressive symptoms and agitated behaviour were identified, but no significant group differences emerged for these and the other domains. The findings of ADS use on PWDs' duration of night-time sleep problems provide some evidence of the benefits of ADS; the findings also support its utility as part of the continuum of care for PWDs and their caregivers. For other behaviour domains, enhanced or more targeted behavioural strategies coupled with ADS might offer caregivers and their PWDs the best possible combination for ameliorating BPSD.
This American study explored whether adult day service (ADS) use was associated with reductions in behavioural and psychological symptoms of dementia (BPSD) in individuals with dementia. A quasi-experimental design was used to compare a group of 133 persons with dementia (PWDs) who initially enrolled in an ADS program to a control group not using these services (n = 68). Caregivers used a 24-hour log on multiple, consecutive days to report on five domains of BPSD. Growth-mixture modelling techniques were used to model change in the BPSD domains over a 2-month period as well as to handle the preponderance of zeros that were inherent in the data. Results showed a relationship between ADS use and caregivers' report of fewer night-time sleep-related problems for their PWDs. Trends for other domains, specifically depressive symptoms and agitated behaviour were identified, but no significant group differences emerged for these and the other domains. The findings of ADS use on PWDs' duration of night-time sleep problems provide some evidence of the benefits of ADS; the findings also support its utility as part of the continuum of care for PWDs and their caregivers. For other behaviour domains, enhanced or more targeted behavioural strategies coupled with ADS might offer caregivers and their PWDs the best possible combination for ameliorating BPSD.
Agitation frequently accompanies cognitive decline among nursing home residents. This study used cross-sectional and longitudinal (up to 18 months) methods to examine agitation among profoundly and moderately impaired residents using both staff report and direct observation methods. The study included participants (N = 78) from a larger study recruited from the Pittsburgh area who completed either 12 or 18 months of data collection. There were four measurement points, each separated by 6-month intervals. Agitation was recorded using two measures: (a) the computer-assisted behavioural observation system (CABOS) and (b) the staff-completed Nursing Home Behavior Problem Scale. Longitudinal hierarchical linear modelling was used to capture the dynamic nature of behaviour change as a function of individual resident characteristics and time. The profoundly cognitively impaired residents displayed more agitation than the moderately impaired group at Epoch 1 (cross-sectional analyses). Longitudinal analysis found a significant linear and quadratic trend only with the profoundly impaired residents using the CABOS. These residents showed slight improvements in agitation up to 12 months, with agitation increasing significantly from 12 to 18 months. With nursing homes receiving an increasing number of profoundly cognitively impaired residents, these results have potential cost and policy implications. Measuring agitation over time by using both staff report and observation measures presents various problems, and the authors present an alternative measure that may help to avoid these difficulties.
Agitation frequently accompanies cognitive decline among nursing home residents. This study used cross-sectional and longitudinal (up to 18 months) methods to examine agitation among profoundly and moderately impaired residents using both staff report and direct observation methods. The study included participants (N = 78) from a larger study recruited from the Pittsburgh area who completed either 12 or 18 months of data collection. There were four measurement points, each separated by 6-month intervals. Agitation was recorded using two measures: (a) the computer-assisted behavioural observation system (CABOS) and (b) the staff-completed Nursing Home Behavior Problem Scale. Longitudinal hierarchical linear modelling was used to capture the dynamic nature of behaviour change as a function of individual resident characteristics and time. The profoundly cognitively impaired residents displayed more agitation than the moderately impaired group at Epoch 1 (cross-sectional analyses). Longitudinal analysis found a significant linear and quadratic trend only with the profoundly impaired residents using the CABOS. These residents showed slight improvements in agitation up to 12 months, with agitation increasing significantly from 12 to 18 months. With nursing homes receiving an increasing number of profoundly cognitively impaired residents, these results have potential cost and policy implications. Measuring agitation over time by using both staff report and observation measures presents various problems, and the authors present an alternative measure that may help to avoid these difficulties.
Aging and Mental Health, 11(3), May 2007, pp.330-338.
Publisher:
Taylor and Francis
This Australian study aimed to investigate the long-term effects of group music therapy on agitation manifested by nursing home residents with Alzheimer's disease. A non-randomised experimental design was employed with one group receiving weekly music therapy (n = 26) and another group receiving standard nursing home care (n = 19). Agitation levels were measured five times over one year using the Cohen-Mansfield Agitation Inventory. Although music therapy participants showed short-term reductions in agitation, there were no significant differences between the groups in the range, frequency, and severity of agitated behaviours manifested over time. Multiple measures of treatment efficacy are necessary to better understand the long-term effects music therapy programs have on this population.
This Australian study aimed to investigate the long-term effects of group music therapy on agitation manifested by nursing home residents with Alzheimer's disease. A non-randomised experimental design was employed with one group receiving weekly music therapy (n = 26) and another group receiving standard nursing home care (n = 19). Agitation levels were measured five times over one year using the Cohen-Mansfield Agitation Inventory. Although music therapy participants showed short-term reductions in agitation, there were no significant differences between the groups in the range, frequency, and severity of agitated behaviours manifested over time. Multiple measures of treatment efficacy are necessary to better understand the long-term effects music therapy programs have on this population.