ENVIRONMENTAL CORRELATES OF RESIDENT AGITATION IN ALZHEIMERS-DISEASE SPECIAL CARE UNITS

OBJECTIVE: To determine the point prevalence of agitated behaviors in a representative sample of Alzheimer's disease Special Care Units, and to determine the extent to which agitation is associated with aspects of the treatment environment, DESIGN: A cross-sectional study in whic h nonparticipant observers recorded 3723 observations of resident beha viors in 53 Alzheimer's disease Special Care Units. Observational data were gathered on the physical environment and staff treatment in thes e settings, and resident characteristics were extracted from a data ba se developed in the study states by the Wealth Care Financing Agency. Analyses studied the association between aspects of the staff and phys ical environment and resident agitation levels, controlling for reside nt cognitive and functional status. SETTING: Special Care Units in nur sing homes in Kansas, Maine, Mississippi, and South Dakota. PARTICIPAN TS: All residents and staff of the participating units. MAIN OUTCOME M EASURES:Eight specific agitated behaviors and two indexes of resident agitation were measured by direct observation by research assistants o n three to four data collection walk-throughs in each of the study fac ilities. RESULTS: The most common agitated behaviors noted were repeti tive mannerisms (4.5% of resident observations) and non-loud verbal ex cess (3.8%). Wandering, which frequently reflects agitation, was noted in 6,5% of resident observations. The proportion of residents exhibit ing an agitated behavior varied from none in some units to 38% in one unit. Independent correlates of low unit agitation levels included fav orable scores on measures of the physical environment and of staff tre atment activities, low rates of physical restraint use, a high proport ion of residents in bed during the day, small unit size, low levels of resident functional dependency, and fewer numbers of comorbid conditi ons. CONCLUSIONS: While the prevalence of agitation tends to increase as Alzheimer's disease progresses, modifiable treatment factors appear to have a strong influence on the prevalence of agitation. Both physi cal design and staff treatment appear to influence agitation rates, as do some measures consistent with a low stimulus approach to Alzheimer 's care.