Pharmacological Management of Challenging Behaviours in People with Dementia

Confined to barracks: The effects of indoor confinement on aggressive behavior among inpatients of an acute psychogeriatric unit

While there is evidence to suggest that in long term residential care settings the provision of more choices and better designed environments have a positive effect on agitation and disturbed behaviors, there are no controlled studies on the effect of imposed confinement in these settings or in acute units.

The effect of mandatory confinement indoors on the incidence of verbal and physical aggression and psychotropic medication use among patients with dementia and associated psychiatric and behavioral disturbance was studied. The setting was an acute psychogeriatric admission unit accommodated in a colonial building originally built as a military barracks. A convenience sample was studied to assess changes in levels of aggression and nurse-initiated psychotropic medication use during and after a 32-day period of indoor confinement. Correlations with gender, diagnosis, pre-admission disturbed behavior and ultimate discharge outcome were examined.

Release from mandatory confinement indoors was correlated with decreases in both verbal and physical aggression as well as medication use. Correlations could be identified between decreases in aggression and male gender, pre-admission aggressive behavior and discharge outcome. Decreased medication use was correlated with discharge outcome. The freedom to go outdoors or have access to extra space should be an important component of the environmental design and care philosophy for the acute admission of people who experience dementia and associated psychiatric and behavioral disturbance.