Agitation: Subtypes and Their Mechanisms

Agitation includes inappropriate verbal, vocal, or motor behaviors that, in the opinion of an observer, do not result directly from the needs or confusion of the agitated individual. Those behaviors affect the well-being of older persons and their caregivers, and therefore also the care rendered to the older person, including the likelihood of institutionalization. The inappropriate nature of agitated behavior is judged from the standpoint of an observer rather than that of the agitated person and may be subject to bias. Research to help clinicians disentangle the meaning of agitation and reduce the effects of observer bias has produced an approach to classification that is useful as a starting point. Agitated behaviors can be divided into physical and verbal, aggressive and non-aggressive. The available literature suggests that the different agitated behaviors have different meanings. Most seem to be associated with discomfort, which may include physical pain, external restraint, or feelings of depression or of loneliness. In contrast, some of the behaviors, especially in the physically nonaggressive category, may be adaptive and not an indication of discomfort. Other behaviors may result directly from neurological damage. On the basis of these interpretations of the reasons for disruptive behaviors, several approaches for treatment follow logically. Although there is much literature on behavioral, environmental, social, and pharmological approaches to treatment of agitation, large well-designed studies are conspicuously lacking. Both good intervention studies and improved methods for tailoring treatment to the specific needs and background of individual elderly persons are needed to better treat this complex phenomenon.