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Towards defining restlessness in individuals with dementia
- Authors:
- REGIER Natalie G., GITLIN Laura N.
- Journal article citation:
- Aging and Mental Health, 21(5), 2017, pp.543-552.
- Publisher:
- Taylor and Francis
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)
Complementary medicine for treatment of agitation and delirium in older persons: a systematic review and narrative synthesis
- Authors:
- LEVY Ilana, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(5), 2017, p.492–508.
- Publisher:
- Wiley
Background: Agitation and delirium frequently occur in cognitively impaired older people. The authors conducted a systematic review with narrative synthesis of the literature aiming to assess effectiveness of complementary and alternative medicine (CAM) modalities to address these conditions. Methods: Following preliminary search, the authors included 40 original researches on CAM treatment of delirium and agitation in older persons. Then, the quality of these studies was assessed using the Downs and Black Checklist and Quality Assessment Tool for Studies with Diverse Designs, and the effect sizes were calculated. The authors subsequently conducted a narrative synthesis of the main findings, including theory development, preliminary synthesis, exploration of relationships within and between that the investigated CAM therapies may ameliorate the severity of agitation and delirium. The physiological surrogates of agitation assessed in these studies included cortisol level, chromogranin A level, and heart rate variability. Very few of the studies systematically assessed safety issues, although no major adverse effects were reported. Conclusion: Overall, the systematic review of the literature suggests that several CAM modalities are potentially beneficial in the treatment of agitation and delirium among older persons. The authors suggest that promising CAM modalities should be further explored through large-scale randomised controlled trials in different clinical settings. (Edited publisher abstract)
Music therapy: a nonpharmacological approach to the care of agitation and depressive symptoms for nursing home residents with dementia
- Authors:
- RAY Kendra D., MITTELMAN Mary S.
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 16(6), 2017, pp.689-710.
- Publisher:
- Sage
Depression, agitation, and wandering are common behaviours associated with dementia and frequently observed among nursing home residents. Even with pharmacological treatment, behaviours often persist, hindering quality of life for elders, their family, and paid caregivers. This study examined the use of music therapy for treatment of these symptoms among 132 people with moderate to severe dementia in nursing homes. Participants were evaluated for depressive symptoms, agitation, and wandering to determine their predominate behaviour. There were two assessments, two weeks apart, prior to intervention, followed by a two-week intervention, and two follow-up assessments, also two weeks apart. A repeated measures ANOVA determined that after two weeks of music therapy, symptoms of depression and agitation were significantly reduced; there was no change for wandering. Multivariate analyses confirmed a relationship between music therapy and change in neuropsychiatric symptoms associated with dementia. Results suggest widespread use of music therapy in long-term care settings may be effective in reducing symptoms of depression and agitation. (Edited publisher abstract)