Decreasing Agitation in Demented Patients Living in Nursing Home Name Institution Abstract This paper discusses the major concern of agitation in patients with dementia living in nursing home care. The epidemiology and significance of the problem is presented as well as evidence based practices observed in several researches that will help decrease agitation in patients with dementia…
Keywords: agitation, dementia, nursing home, nurse leader, evidence based practice Decreasing Agitation in Demented Patients Living in Nursing Home Behavioral and emotional disturbances, particularly agitation, are the major problems commonly observed in impaired elderly people dwelling in nursing homes, particularly those who are suffering of dementia. According to Tariot, Daiello and Ismail (2002, p. 2), behavioral symptoms affect a large population of dementia patients in the United States, where “as many as 90% of patients with dementia develop significant behavioral disorders at some point.” Based on a clinical research conducted by Bartels, et al. (2003, p. 236), the condition of patients with dementia is “complicated by mixed agitation and depression accounts for over one-third of complicated dementia”. Compared with other subgroups, elderly patients with dementia which are also experiencing bouts of agitation have the “highest rate of hospitalization, the greatest number of medical diagnoses, and the greatest medical severity, and they receive the greatest number of psychiatric medications (Bartels, et. al. 2003, p. 234)”. As such, there is a great need to decrease agitation in dementia patients especially in the nursing home settings. Studies on psychiatric disorders recommend that agitation symptoms in patients with dementia should be efficiently treated through proper diagnosis and medication, together with the efficient management of the nurses and caregivers in enhancing the clinical outcomes according to evidence based practices (Salzman, et al., 2008). Cohen-Mansfield, Marx and Rosenthal (1990, p. 3) defined agitation as “inappropriate verbal, vocal, or motor activity that is not a necessary by-product of the needs or confusion of the agitated individual.” Agitated behavior may be manifested as an appropriate behavior executed with inappropriate rate of recurrence or it may be inappropriate based on social standards for the particular situation, as exemplified by the three syndromes such as aggressive behaviors, physically non-aggressive behaviors, and verbally agitated behaviors. The abusive or aggressive behavior of a patient may be directed towards him or others and are often apparent in the advanced stages of dementia. Physically non-aggressive behaviors are observed as adaptive to nursing home residents during their deteriorated stage of dementia, where their bodies need to be stimulated or undergo physical exercise. Verbally agitated behaviors are regarded as a form of help-seeking behaviors by patients that are experiencing depression and physical diseases (Cohen-Mansfield, Marx and Rosenthal, 1990). In addition, agitation may be brought by various physical and emotional factors like fears, insecurity, frustrations, and false beliefs brought about by impaired hearing, sight, or aphasia, most commonly observed in persons with cognitive impairment (Cohen-Mansfield, Marx and Rosenthal, 1990). There are also reports that nursing home staff frequently misapprehends symptoms of cognitive impairment as agitation instead of thoroughly checking if the said behavior stems from other reasons such as pain, hunger, boredom, fatigue, environmental chaos, or consequence of medical issues or medications. Sedatives and atypical antipsychotic drugs are usually administered to patients exhibiting dementia-associated agitation and ...
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