Behavoir-Other Causes of Aggressive

Other Causes of Aggressive Behavoir

The Nonpharmacologic Management of Agitation in the Nursing Home:
A Consensus Approach
Source: Nursing Home Medicines

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Underlying Causes

Agitation is not a random behavior. It results from underlying distress experienced by the elderly person. This distress can stem from cognitive impair-ment, psychiatric and medical disorders, and functional impairments.

Cognitive Impairment

The existing literature strongly suggests that deficits in cognitive function are the most important factors predisposing individuals to agitation. Cohen-Mansfield et all found that the degree of cognitive
impairment is correlated with the type of agitated behavior.

Individuals with severe cognitive impair-ment manifested aggressive behaviors and physically nonaggressive behaviors to an equal degree.

Individuals with intermediate impairment had a higher level of nonaggressive behaviors.

Individuals with higher cognitive status exhibited verbally agitated behaviors more frequently.

Medical Disorders

Medical illnesses (eg, upper respiratory tract infections, urinary tract infections, constipation, and chronic pain) in cognitively impaired individuals commonly result in agitated behavior that ranges from mild to severe forms of delirium.

Medical Disorders continued

Verbal agitation has been found to be the most common manifestation in patients with underlying medical conditions. A newly prescribed medication, such as high-dose steroids, may precipitate agitation or psychotic events.

Functional Impairments

Hearing, vision, and mobility impairments can increase the sense of isolation experienced by cognitively impaired residents. The panel felt that these impairments could contribute to misperceptions of the environment and could result in delusions, hallucinations, and associated agitation.

Loss of abilities for self-care and mobility can cause increased feelings of helplessness, isolation, and boredom. This can worsen agitated behaviors.

Hunger, thirst, or need for toileting may result in agitation if the patient is unable to fulfill or express these needs because of functional impairment

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Another one on behavior is this one about using neuroleptic medications in Nursing Homes and gives you the forms which should be used to rate agitation levels in a patient

OBRA Regulations and Neuroleptic Use: Defining Agitation Using the Pittsburgh Agitation Scale and the Neurobehavioral Rating Scale Defining Agitation Rating Scale