Behavioral Problems in Community‐Dwelling People with Dementia

Meredeth A. Rowe, RN, PhD, Zeta Iota & Zeta Upsilon, Associate Professor and Clinical Nurse Specialist at the Alzheimer’s Disease Assistance Center, Decker School of Nursing, Binghamton University, Binghamton, NY; Jo A. Straneva, RN, DN, CS, Zeta Iota, Director, Lourdes Breast Care Center, Binghamton, NY; Kathleen Byrne Colling, RN, PhD, Zeta Iota, Research Scientist and Lecturer, School of Nursing, University of Michigan, Ann Arbor, MI; Theresa Grabo, RN, PhD, CS, CRNP, Zeta Iota, Associate Professor and Family Nurse Practitioner, Decker School of Nursing, Binghamton University, Binghamton, NY. Correspondence to Dr. Rowe, Decker School of Nursing, Binghamton University, Binghamton, NY 13902-6000. E-mail: mrowe@binghamton.edu Accepted for publication March 17, 1999. Increasing evidence shows that behavioral problems place a significant burden on home caregivers of those with dementia (Hamel et al., 1990; Swearer, Drachman, O’Donnell, & Mitchell, 1988; Teri, Borson, Kiyak, & Yamagishi, 1989). The purpose of our small study was to describe the incidence of burdensome behaviors using a newly developed classification scheme. Currently no widely accepted typology for behavioral problems that occur with dementia exists (Taft & CroninStubbs, 1995). After a review of the literature, particularly work by Cohen-Mansfield, Werner, and Marx (1989), behavioral problems were classified as verbally agitated, physically agitated, verbally aggressive, and physically aggressive as shown in the Table. Verbally agitated behaviors are inappropriate vocalizations that disturb self or others. Physical agitation is inappropriate motor activity that disturbs self or others. Forceful vocalizations that are potentially harmful to self or others are classified as verbally aggressive. Physically aggressive behaviors are forceful motor activities that are potentially harmful to self or others. Behaviors were considered problematic only if they were observed by the caregiver and required supervision or intervention. Data were collected from a retrospective review of records for the years 1992-1996 conducted in the northeastern United States. Subjects were persons with dementia who had been evaluated at a community-based clinic for the diagnosis of dementia. Data were obtained from records of extensive medical, nursing, and social work interviews and evaluations performed in the home and the clinic by staff specialized in gerontology. The form for data collection included information about behavioral problems, past and present medical conditions, and the results of standardized cognitive and psychological tests. Clinical records based on caregiver interviews and patient evaluations were reviewed to determine the presence of any problematic behaviors. Behavioral categories were dichotomously scored as present or absent, depending on whether any of the typifying behaviors were exhibited. Twenty-three of the original 81 records did not meet inclusion criteria because of incomplete data or diagnoses other than dementia; 58 subjects with confirmed diagnoses of dementia were studied. Dementia subjects ranged in age from 52 to 93 years (mean = 78), and were predominately Caucasians (>90%), women (65%), and married (57%); 19% lived alone. Behavioral Problems in Community-Dwelling People with Dementia