Aggression and Alzheimer's

Aging Today, May/June 2003 | Go to article overview

Aggression and Alzheimer's


Cursing, hitting, grabbing, kicking, pushing, throwing things, scratching, screaming, biting and making strange noises: This list defines the range of aggressive behaviors that the practitioners in nursing facilities that specialize in Alzheimer's care may experience every day. "With aggressive behavior remaining costly and a danger to residents and staff alike, the design of an effective intervention is critical," states Beth A. D. Nolan in her doctoral research, "The Association of Aggression With Physical and Cognitive Functioning in Dementia of the Alzheimer's Type: A Longitudinal Analysis."

Nolan, a graduate research assistant in the Gerontology Department at the University of Kansas, Lawrence, delved into the potential causes of aggressive actions by long-term care residents with Alzheimer's and related dementias and teased out surprising findings about the significant role of residents' impaired ability to recognize things, such as faces and places. She conducted her research as part of the National Institute on Aging Special Care Unit Initiative to study the outcomes of special care units in long-term care facilities for patients with Alzheimer's-type dementia. The AARP Foundation endows the ASA Graduate Student Research Award.

$52,000 PER YEAR

In her initial review of related professional literature, Nolan cited a 2002 study by Gary W. Small and colleagues (Journal of the American Geriatrics Society, February 2002) showing that nursing home care for residents with Alzheimer's averages $52,000 per year in direct and indirect costs. Another article by M.S. Beeri and coauthors in the International Journal of Geriatric Psychiatry (May 2002) attributed 25%-35% of the annual cost of institutional Alzheimer's care to managing behavior problems. Other research revealed the prevalence of aggressive behavior ranging from at least 52% to as high as 91% of residents, depending on the institutional setting (a study at a Veterans Administration facility yielded the highest level), study methodology and varying definitions of aggression.

Nolan conducted three evaluations-at the beginning, middle and end of her one-year project-of residents with a diagnosis of Alzheimer's-type dementia at 87 nursing facilities in Michigan, North Carolina and Washington. These facilities included 52 homes with special-care units and 35 institutions providing care to people with Alzheimer's that did not designate special units. The mean age of participants was 89.68 years, and 68% were women. The initial assessment included 413 residents; 338 were evaluated six months later; and 287 remained in the study to be examined six months after that. …

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