The prevalence of significant behavioural disturbance in 46 Sydney nur
sing homes was examined. All 2445 residents were rated on a brief scre
ening questionnaire by senior nurses, who decided that 704 (29%) displ
ayed at least one problem behaviour for much of the time. Primary care
nurses (PCNs) then rated these 'screen-positive' residents using the
Cohen-Mansfield Agitation Inventory (CMAI). In one nursing home the PC
Ns rated all 100 residents on the CMAI and found that 24 of 58 'screen
-negative' residents displayed CMAI behaviours once daily or more. Of
CMAI behaviours rated as occurring daily or more often, 30% were manif
ested by 'screen-negative' residents. Prevalence figures based on 'scr
een-positive' residents are underestimates. Interrater reliability bet
ween PCNs was good. We report that at least 3.3% of residents paced an
d 0.45% screamed several times an hour. Each of the following behaviou
rs was manifested daily or more often by 10-15% of the residents: rest
lessness, pacing, repetitive sentences, constant calls for help, cursi
ng/verbal aggression and complaining. Aggressive behaviours (eg hittin
g, kicking, biting) were less common, and a relationship to cognitive
impairment was demonstrated. Increased research on assessment and mana
gement of these behaviours is needed.