Study Examines Factors Associated with Increased Aggression in Veterans with Dementia
Aggressive behavior is among the most distressing and dangerous of symptoms experienced by individuals with dementia. Aggression presents a serious challenge for caregivers, possibly placing them at risk for harm, and increasing the risk of psychotropic medication use and nursing-home placement. As part of a larger longitudinal study of the causes and consequences of aggression in patients with dementia, this study sought to examine the factors predicting the development of aggression among Veterans with dementia. Moreover, this is the first longitudinal study to examine both direct and indirect relationships between psychological factors and time to onset of aggression. Investigators identified 171 non-aggressive, community-dwelling VA patients older than age 60, who were newly diagnosed with dementia. Both Veterans and their caregivers were assessed over 24 months starting at baseline, and then at months 5, 9, 13, 17, 21, and 25. Investigators examined aggression and agitation, non-aggressive agitation (i.e., pacing, repetitious mannerisms), dementia severity, depression, worst pain (highest level of pain over the past 4 weeks), as well as the relationship between the Veteran and his/her primary caregiver (i.e., frequency of communication, engaging interaction, attachment, emotional support). They also assessed caregiver burden.
Findings show that potentially mutable factors were associated with the development of aggression in Veterans with newly diagnosed dementia. Mutable factors that predicted increased risk of aggression included: higher levels of baseline caregiver burden, worst patient pain, declining patient-caregiver relationship, and increasing non-aggressive physical agitation. Baseline dementia severity and depression were indirectly related to the onset of aggression.
Effective interventions are available to address each of these factors; therefore, these findings have important preventive and treatment implications for the almost 40% of patients suffering from dementia that exhibit aggressive behavior each year.
Morgan R, Sail K, Snow A, Davila J, Fouladi N, and Kunik M. Modeling causes of aggressive behavior in patients with dementia. The Gerontologist October 26, 2012;e-pub ahead of print.
This study was funded by HSR&D (IIR 01-159). Drs. Davila and Kunik are part of HSR&D's Houston Center for Quality of Care and Utilization Studies.