Agitation in demented patients in an acute care hospital: Prevalence, disruptiveness, and staff burden

Background/literature review: The prevalence of agitated behaviors in diffe rent populations with dementia is between 24% and 98%. Although agitated be haviors are potentially disruptive, little research attention has been focu sed on the effects of these behaviors upon nursing staff. The objectives of this study of demented patients in long-term-care beds at an acute care co mmunity hospital were to determine the frequency and disruptiveness of agit ated behaviors; to investigate the associations of patient characteristics and interventions with the level of agitation; and to explore the burden of these agitated behaviors on nursing staff. Method: The study sample compri sed 56 demented patients in the long-term-care unit during the study period . Twenty-seven staff who cared for these patients during three shifts over a 2-week period were interviewed to rate the frequency and disruptiveness o f agitated behaviors using the Cohen-Mansfield Agitation Inventory, and the burden of care using a modified version of the Zarit Burden Interview. Dat a on patient characteristics and interventions extracted from the hospital chart included scores on the Barthel Index and Mini-Mental State Examinatio n, the use of psychotropic medication, and the use of physical restraints. Results: Ninety-five percent of the patients with dementia were reported to have at least one agitated behavior; 75% had at least one moderately disru ptive behavior. A small group of six patients (11%) had 17 or more disrupti ve behaviors. The frequency of most behaviors did not vary significantly by shift. Length of stay on long-term care, Barthel Index score, and the use of psychotropic medications were significantly associated with the number o f agitated behaviors. The number of behaviors, their mean frequency, and th eir mean disruptiveness were all significantly correlated with staff burden . Discussion: The prevalence of agitated behaviors in patients with dementi a in long-term-care beds at an acute care hospital is similar to that repor ted in long-term-care facilities. These behaviors are associated with staff burden.