Dementia, Agitation, and Care in the Nursing Home

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Abstract
Objective: To examine the behavioral and functional problems of the cognitively impaired.Design: A survey of a cohort of residents from six nursing homes.Participants: Subjects were randomly selected based on a minimum age of 70 years and a Resource Utilization Group (RUG) classification of the Physical or Behavioral type. Of those eligible, 44% (n = 366) agreed to participate. The participants and non‐participants had similar demographics except for a higher incidence of mental illness in the non‐participant group, which did not have a significant impact on agitation.Setting: Six nursing homes in New York City, three voluntary non‐profit and three proprietary.Measurement: The study used chart review, assessment of residents' cognitive and functional abilities, nursing assistants' ratings of residents' functional abilities, behavioral problems, and the amount of effort required in care, and time‐motion observations of staff‐resident interactions.Results: Residents' level of cognitive impairment had a significant impact on problem behaviors during ADL tasks, along with supervision required in patient care (P < 0.05). These results were validated by time‐motion analysis. Regression analysis revealed that for non‐demented subjects, the best indicator of care needs was health status, while for demented residents the best indicator was cognitive status (P < 0.0003).Conclusions: The care needs of residents with dementia are better estimated by a mental status test for cognitive impairment then by ADL assessment alone. Greater agitation is associated with increasing cognitive impairment. Further, agitation and behavioral problems associated with care result in a need for increased staff supervision.