1
|
Wong B, Wu P, Ismail Z, Watt J, Goodarzi Z. Detecting agitation and aggression in persons living with dementia: a systematic review of diagnostic accuracy. BMC Geriatr 2024; 24:559. [PMID: 38926638 PMCID: PMC11210082 DOI: 10.1186/s12877-024-05143-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE 40-60% of persons living with dementia (PLWD) experience agitation and/or aggression symptoms. There is a need to understand the best method to detect agitation and/or aggression in PLWD. We aimed to identify agitation and/or aggression tools that are validated against a reference standard within the context of PLWD. METHODS Our study was registered on PROSPERO (CRD42020156708). We searched MEDLINE, Embase, and PsycINFO up to April 22, 2024. There were no language or date restrictions. Studies were included if they used any tools or questionnaires for detecting either agitation or aggression compared to a reference standard among PLWD, or any studies that compared two or more agitation and/or aggression tools in the population. All screening and data extraction were done in duplicates. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Data extraction was completed in duplicates by two independent authors. We extracted demographic information, prevalence of agitation and/or aggression, and diagnostic accuracy measures. We also reported studies comparing the correlation between two or more agitation and/or aggression tools. RESULTS 6961 articles were screened across databases. Six articles reporting diagnostic accuracy measures compared to a reference standard and 30 articles reporting correlation measurements between tools were included. The agitation domain of the Spanish NPI demonstrated the highest sensitivity (100%) against the agitation subsection of the Spanish CAMDEX. Single-study evidence was found for the diagnostic accuracy of commonly used agitation scales (BEHAVE-AD, NPI and CMAI). CONCLUSIONS The agitation domain of the Spanish NPI, the NBRS, and the PAS demonstrated high sensitivities, and may be reasonable for clinical implementation. However, a limitation to this finding is that despite an extensive search, few studies with diagnostic accuracy measurements were identified. Ultimately, more research is needed to understand the diagnostic accuracy of agitation and/or aggression detection tools among PLWD.
Collapse
Affiliation(s)
- Britney Wong
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Pauline Wu
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer Watt
- Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zahra Goodarzi
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
2
|
Cummings J, Lanctot K, Grossberg G, Ballard C. Progress in Pharmacologic Management of Neuropsychiatric Syndromes in Neurodegenerative Disorders: A Review. JAMA Neurol 2024; 81:645-653. [PMID: 38558015 PMCID: PMC11164642 DOI: 10.1001/jamaneurol.2024.0586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Importance Neuropsychiatric syndromes (NPSs) are common in neurodegenerative disorders (NDDs); compromise the quality of life of patients and their care partners; and are associated with faster disease progression, earlier need for nursing home care, and poorer quality of life. Advances in translational pharmacology, clinical trial design and conduct, and understanding of the pathobiology of NDDs are bringing new therapies to clinical care. Observations Consensus definitions have evolved for psychosis, agitation, apathy, depression, and disinhibition in NDDs. Psychosocial interventions may reduce mild behavioral symptoms in patients with NDD, and pharmacotherapy is available for NPSs in NDDs. Brexpiprazole is approved for treatment of agitation associated with Alzheimer disease dementia, and pimavanserin is approved for treatment of delusions and hallucinations associated with psychosis of Parkinson disease. Trials are being conducted across several of the NDDs, and a variety of mechanisms of action are being assessed for their effect on NPSs. Conclusions and Relevance Detection and characterization of NPSs in patients with NDDs is the foundation for excellent care. New definitions for NPSs in NDDs may inform choices regarding clinical trial populations and translate into clinical practice. Psychosocial and pharmacologic therapies may reduce behavioral symptoms and improve quality of life for patients and caregivers. Approved agents may establish regulatory precedents, demonstrate successful trial strategies, and provide the foundation for further advances in treatment development.
Collapse
Affiliation(s)
- Jeffrey Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas
| | - Krista Lanctot
- Departments of Psychiatry and Pharmacology, University of Toronto, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - George Grossberg
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St Louis, Missouri
| | - Clive Ballard
- Exeter University Medical School, University of Exeter, Exeter, United Kingdom
| |
Collapse
|
3
|
Guu T, Brem A, Albertyn CP, Kandangwa P, Aarsland D, ffytche D. Wrist-worn actigraphy in agitated late-stage dementia patients: A feasibility study on digital inclusion. Alzheimers Dement 2024; 20:3211-3218. [PMID: 38497216 PMCID: PMC11095432 DOI: 10.1002/alz.13772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Wrist-worn actigraphy can be an objective tool to assess sleep and other behavioral and psychological symptoms in dementia (BPSD). We investigated the feasibility of using wearable actigraphy in agitated late-stage dementia patients. METHODS Agitated, late-stage Alzheimer's dementia care home residents in Greater London area (n = 29; 14 females, mean age ± SD: 80.8 ± 8.2; 93.1% White) were recruited to wear an actigraphy watch for 4 weeks. Wearing time was extracted to evaluate compliance, and factors influencing compliance were explored. RESULTS A high watch-acceptance (96.6%) and compliance rate (88.0%) was noted. Non-compliance was not associated with age or BPSD symptomatology. However, participants with "better" cognitive function (R = 0.42, p = 0.022) and during nightshift (F1.240, 33.475 = 8.075, p = 0.005) were less compliant. Female participants were also marginally less compliant (F1, 26 = 3.790, p = 0.062). DISCUSSIONS Wrist-worn actigraphy appears acceptable and feasible in late-stage agitated dementia patients. Accommodating the needs of both the patients and their carers may further improve compliance.
Collapse
Affiliation(s)
- Ta‐Wei Guu
- Department of Old Age PsychiatryInstitute of PsychiatryPsychology and Neuroscience, King's College LondonLondonUK
- Division of PsychiatryDepartments of Internal MedicineChina Medical University Beigang HospitalYunlinTaiwan
- Sleep Medicine Center and Mind‐Body Interface Laboratory (MBI‐Lab)China Medical University HospitalTaichungTaiwan
| | - Anna‐Katharine Brem
- Department of Old Age PsychiatryInstitute of PsychiatryPsychology and Neuroscience, King's College LondonLondonUK
- University Hospital of Old Age Psychiatry, University of BernBernSwitzerland
| | - Christopher P. Albertyn
- Department of Old Age PsychiatryInstitute of PsychiatryPsychology and Neuroscience, King's College LondonLondonUK
| | - Pooja Kandangwa
- Department of Old Age PsychiatryInstitute of PsychiatryPsychology and Neuroscience, King's College LondonLondonUK
| | - Dag Aarsland
- Department of Old Age PsychiatryInstitute of PsychiatryPsychology and Neuroscience, King's College LondonLondonUK
- Centre for Age‐Related MedicineStavanger University HospitalStavangerNorway
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation TrustLondonUK
| | - Dominic ffytche
- Department of Old Age PsychiatryInstitute of PsychiatryPsychology and Neuroscience, King's College LondonLondonUK
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation TrustLondonUK
| |
Collapse
|
4
|
Grossberg G, Urganus A, Schein J, Bungay R, Cloutier M, Gauthier-Loiselle M, Chan D, Guerin A, Aggarwal J. A real-world assessment of healthcare costs associated with agitation in Alzheimer's dementia. J Med Econ 2024; 27:99-108. [PMID: 38073468 DOI: 10.1080/13696998.2023.2291966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/04/2023] [Indexed: 12/27/2023]
Abstract
AIMS To describe and compare clinical characteristics, healthcare costs, and institutionalization/mortality outcomes among patients with and without agitation associated with Alzheimer's dementia (AAD). METHODS Data from the Reliant Medical Group database (01/01/2016-03/31/2020) were used, including claims, electronic medical records, and clinical information/physician notes abstracted from medical charts. Patients aged ≥55 years with Alzheimer's dementia (AD) were observed during a randomly selected 12-month study period after AD diagnosis. Using information recorded in medical charts, patients were classified into cohorts based on experiencing (agitation cohort) and not experiencing (no agitation cohort) agitated behaviours during the study period. Entropy balancing was used to create reweighted cohorts with similar characteristics. Study outcomes (patient demographic and clinical characteristics, treatments received, healthcare costs, institutionalization and death events) were compared between cohorts; agitation characteristics were described for the agitation cohort only. RESULTS Among 711 patients included in the study, 240 were classified in the agitation cohort and 471 in the no agitation cohort. After reweighting, several comorbidities were more frequently observed in the agitation versus no agitation cohort, including infection, depression, and altered mental status. Use of antidepressants, anticonvulsants, antipsychotics, and antianxiety medications was more common in the agitation versus no agitation cohort. Common agitated behaviours included hitting (20.8%), pacing/aimless wandering (17.5%), and cursing/verbal aggression (15.0%). Total all-cause healthcare costs were $4287 per-patient-per-year higher in the agitation cohort versus no agitation cohort (p = 0.04), driven by higher inpatient costs. Death was more common and time to death and institutionalization were shorter in the agitation versus no agitation cohort. LIMITATIONS Results may not be generalizable to the US population with AD. CONCLUSIONS Among patients with AD, agitation was associated with shorter time to death/institutionalization and increased comorbidities, medication use, and healthcare costs, highlighting the additional clinical and economic burden that agitation poses to patients and the healthcare system.
Collapse
Affiliation(s)
- George Grossberg
- Department of Psychiatry & Behavioral Neuroscience, Division of Geriatric Psychiatry, St Louis University School of Medicine, MO, USA
| | | | - Jeff Schein
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | | | | | | | | | | | - Jyoti Aggarwal
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| |
Collapse
|
5
|
He X, Hao J, Song Y, Cao H, Chen Y, Yang H. Effectiveness of non-pharmacological interventions for sleep disturbances in people living with dementia: A systematic review and meta-analysis. Geriatr Nurs 2023; 51:76-83. [PMID: 36921396 DOI: 10.1016/j.gerinurse.2023.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 03/14/2023]
Abstract
We summarize the evidence on non-pharmacological interventions for sleep disturbances in people living with dementia(PlwD). A literature search was performed using PubMed, Embase, Cochrane library, Web of Science, PsycINFO, CINAHL, and clinicaltrials.gov. Up to August 20, 2022. Six studies met our eligibility criteria. Light therapy, the therapeutic pet-type robotic seal(PRAO), and slow-stroke back massage(SSBM) are non-pharmacological interventions for sleep disturbances in PlwD.PARO increased night-time sleep duration (p < 0.05). The benefit of SSBM for sleep disturbances in PlwD is unclear (p > 0.05). Although there is a lack of evidence for the effect of light therapy on sleep disturbances in PlwD (p > 0.05), light therapy reduced sleep disturbance (SMD = -0.38; 95% CI:1.25, 0.48), increased sleep efficiency (MD = 3.77; 95% CI:-0.23, 7.78), and also reduced depression (MD = -2.49; 95% CI: -2.92, -2.06). More large-scale randomized controlled trials are needed and consider combining multiple non-pharmacological measures for sleep interventions in PlwD.
Collapse
Affiliation(s)
- Xingyue He
- Nursing College of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jiaqi Hao
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China; Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, Changsha, China
| | - Yejun Song
- Department of Nursing, The Third people's Hospital of Taiyuan, Taiyuan, Shanxi, China
| | - Huili Cao
- Nursing College of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yangjie Chen
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Hui Yang
- Nursing College of Shanxi Medical University, Taiyuan, Shanxi, China; Department of Nursing, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
| |
Collapse
|
6
|
Khandker RK, Chekani F, Mirchandani K, Kathe N. Economic outcomes associated with diagnosed behavioral symptoms among patients with dementia in the United States: a health care claims database analysis. BMC Geriatr 2023; 23:99. [PMID: 36797678 PMCID: PMC9936641 DOI: 10.1186/s12877-023-03780-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Behavioral symptoms are common in patients with dementia. However, there is limited evidence of their economic burden. Among commercially insured patients with dementia in the United States, this study assessed the prevalence of diagnosed behavioral symptoms and whether healthcare resources utilization and costs were associated with these symptoms. METHODS This retrospective observational study was conducted using the IBM® MarketScan® Commercial Claims and Encounters and Medicare Supplemental database from October 1, 2015, to September 30, 2019. Diagnoses of dementia and behavioral symptoms were identified using the International Classification of Diseases, 10th Modification codes. To test differences in patient characteristics among those with and without diagnosed behavioral symptoms, t-tests were used for continuous variables, and chi-square tests were used for categories. Generalized linear models were used to compare healthcare resource utilization and costs between patients with and without diagnosed behavioral symptoms, adjusted for baseline characteristics. RESULTS Of the 62,901 patients with dementia included in the analysis, 16.5% had diagnosed behavioral symptoms 12 months post dementia diagnosis. Patients with diagnosed behavioral symptoms used more health care resources (mean annual pharmacy visits per patient: 39.83 vs. 33.08, mean annual outpatient visits per patient: 24.20 vs. 16.94, mean annual inpatient visits per patient: 0.98 vs. 0.47, mean annual ER visits per patient: 2.45 vs. 1.21) and incurred higher cost of care than those without diagnosed behavioral symptoms (mean annual total health care costs per patients: $63,268 versus $33,383). Inpatient care was the most significant contributor to total costs (adjusted annual mean cost per patient: $28,195 versus $12,275). CONCLUSION Behavioral symptoms were significantly associated with higher healthcare resource utilization and costs among patients with dementia. Further research is warranted to address the unmet medical needs of this patient population.
Collapse
Affiliation(s)
- Rezaul Karim Khandker
- grid.417993.10000 0001 2260 0793Center of Observational and Real-World Evidence, Merck & Co., Inc, 351 North Sumneytown Pike, North Wales, PA USA
| | - Farid Chekani
- Center of Observational and Real-World Evidence, Merck & Co., Inc, 351 North Sumneytown Pike, North Wales, PA, USA.
| | | | | |
Collapse
|
7
|
Chen K, Li H, Yang L, Jiang Y, Wang Q, Zhang J, He J. Comparative efficacy and safety of antidepressant therapy for the agitation of dementia: A systematic review and network meta-analysis. Front Aging Neurosci 2023; 15:1103039. [PMID: 36936502 PMCID: PMC10020338 DOI: 10.3389/fnagi.2023.1103039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Background Dementia is a clinical syndrome commonly seen in the elderly individuals. With the prevalence of dementia, the incidence of neuropsychiatric symptoms in dementia patients is increasing annually. Agitation, as one of the neuropsychiatric symptoms, has a serious impact on the quality of life of patients with dementia. Several antidepressant drugs have been shown to be effective for treating agitated behavior symptoms in patients with dementia, but there are no direct comparisons among those drugs. Therefore, we carried out a network meta-analysis (NMA) to examine the efficacy and safety of those antidepressant drugs. Methods We searched eight databases (PubMed, Cochrane Library, Web of Science, Embase, Wanfang Database, China National Knowledge Infrastructure, VIP Database and China biomedical literature service) from their inception to 6 November 2022. Randomized controlled trials (RCTs) reporting the efficacy and safety of antidepressant drugs in treating agitated behavior symptoms in patients with dementia were included in our analysis. The quality assessment was carried out by two researchers individually and the analysis was based on the frequency method. Results Twelve articles with 1,146 participants were included in our analysis. Based on the outcome of the agitation score, treatment with citalopram (standardized mean difference, SMD = -0.44, 95% confidence interval, 95% CI = -0.72 to -0.16) showed significant benefits over the placebo group. Treatment with trazodone (odds ratio, OR = 4.58, 95% CI = 1.12-18.69) was associated with a higher risk of total adverse events compared with a placebo treatment. Conclusion Among the antidepressant drugs included in this study, treatment with citalopram was probably the only optimal intervention, when considering the improvement from baseline to the end of the intervention, and there was not a statistically significant difference in safety when compared with a placebo treatment. Systematic review registration https://www.crd.york.ac.uk/prospero/#recordDetails, identifier: PROSPERO, CRD42022320932.
Collapse
Affiliation(s)
- Kaili Chen
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Haiqi Li
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Le Yang
- Department of Endocrinology, Jilin Province People's Hospital, Changchun, China
| | - Yan Jiang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qiaoli Wang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jiao Zhang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jinting He
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Jinting He
| |
Collapse
|
8
|
Cost-effectiveness of mirtazapine for agitated behaviors in dementia: findings from a randomized controlled trial. Int Psychogeriatr 2022; 34:905-917. [PMID: 35852256 DOI: 10.1017/s1041610222000436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To examine the costs and cost-effectiveness of mirtazapine compared to placebo over 12-week follow-up. DESIGN Economic evaluation in a double-blind randomized controlled trial of mirtazapine vs. placebo. SETTING Community settings and care homes in 26 UK centers. PARTICIPANTS People with probable or possible Alzheimer's disease and agitation. MEASUREMENTS Primary outcome included incremental cost of participants' health and social care per 6-point difference in CMAI score at 12 weeks. Secondary cost-utility analyses examined participants' and unpaid carers' gain in quality-adjusted life years (derived from EQ-5D-5L, DEMQOL-Proxy-U, and DEMQOL-U) from the health and social care and societal perspectives. RESULTS One hundred and two participants were allocated to each group; 81 mirtazapine and 90 placebo participants completed a 12-week assessment (87 and 95, respectively, completed a 6-week assessment). Mirtazapine and placebo groups did not differ on mean CMAI scores or health and social care costs over the study period, before or after adjustment for center and living arrangement (independent living/care home). On the primary outcome, neither mirtazapine nor placebo could be considered a cost-effective strategy with a high level of confidence. Groups did not differ in terms of participant self- or proxy-rated or carer self-rated quality of life scores, health and social care or societal costs, before or after adjustment. CONCLUSIONS On cost-effectiveness grounds, the use of mirtazapine cannot be recommended for agitated behaviors in people living with dementia. Effective and cost-effective medications for agitation in dementia remain to be identified in cases where non-pharmacological strategies for managing agitation have been unsuccessful.
Collapse
|
9
|
Schein J, Houle CR, Urganus AL, Jones E, Pike J, Husbands J, Willey CJ. The Impact of Agitation in Dementia on Caregivers: A Real-World Survey. J Alzheimers Dis 2022; 88:663-677. [PMID: 35694920 PMCID: PMC9398061 DOI: 10.3233/jad-215670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Dementia patients frequently depend on caregivers. Agitation is a common behavioral dementia symptom particularly burdensome to patients and caregivers. Objective: To assess the association of agitation severity with non-professional caregiver hours, burden, health status, and productivity. Secondarily, to assess the association of agitation severity with these outcomes for patients receiving remote (not living with the patient) and proximate (living with the patient) caregiving. Methods: A retrospective analysis of physician and non-professional caregiver-reported data from a US point-in-time survey. Patients were aged ≥50 years, with early cognitive impairment or dementia. Regression analyses compared outcomes by agitation severity; covariates included age, sex, and clinical characteristics. Results: Data were included for 1,349 patients (non-agitated n = 656, agitated n = 693; no care n = 305, remote care n = 248, proximate care n = 691; unknown care n = 105). Greater agitation was significantly associated (p < 0.05) in all caregivers with increasing: Zarit Burden Interview (ZBI) Total Caregiver Burden, Personal Strain, Role Strain, and Guilt; Work Productivity and Activity Index (WPAI) presenteeism, overall work impairment, and total activity impairment. Higher ZBI Total Caregiver Burden, Personal Strain, and Role Strain were associated with greater agitation in proximate caregivers and higher ZBI Guilt associated with greater agitation in remote caregivers (p < 0.05). Higher WPAI presenteeism and total activity impairment were associated (p < 0.05) with greater agitation in proximate caregivers. Caregiving hours increased with increasing agitation for proximate caregiving (p = 0.001). Conclusion: Greater agitation severity was associated with higher caregiver burden and lower productivity, with higher indirect costs a likely outcome of agitation.
Collapse
Affiliation(s)
- Jeff Schein
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, NJ, USA
| | | | | | | | | | | | - Cynthia J. Willey
- Division of Health Outcomes, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| |
Collapse
|
10
|
Zhu Y, Song T, Zhang Z, Deng C, Alkhalaf M, Li W, Yin M, Chang HCR, Yu P. Agitation Prevalence in People With Dementia in Australian Residential Aged Care Facilities: Findings From Machine Learning of Electronic Health Records. J Gerontol Nurs 2022; 48:57-64. [PMID: 35343838 DOI: 10.3928/00989134-20220309-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Using a suite of artificial intelligence technologies, the current study sought to determine the prevalence of agitated behaviors in people with dementia in residential aged care facilities (RACFs) in Australia. Computerized natural language processing allowed extraction of agitation instances from the free-text nursing progress notes, a component of electronic health records in RACFs. In total, 59 observable agitated behaviors were found. No difference was found in dementia prevalence between female and male clients (44.1%), across metropolitan and regional facilities (42.1% [SD = 17.9%]), or for agitation prevalence in dementia (76.5% [SD = 18.4%]). The top 10 behaviors were resisting, wandering, speaking in excessively loud voice, pacing, restlessness, pushing, shouting, complaining, frustration, and using profane language. Four to 17 agitated behaviors coexisted in 53% of people with dementia agitation, indicating high caregiver burden in these RACFs. Improving workforce training and redesigning care models are urgent for sustainability of dementia care in RACFs. [Journal of Gerontological Nursing, 48(4), 57-64.].
Collapse
|