The relation of premorbid factors to aggressive physical behavior in dementia

Aggressive physical behaviour (APB) is common in persons with dementia and often leads to negative consequences such as use of restraints and staff member burnout. For the past several years, a group of nurse researchers has collaborated to develop a model that views dementia behaviors as need-driven but dementia-compromised. The model posits that background variables of the demented person interact with proximal (or current situational) variables to produce APB. The purpose of this study was to test a part of that model by addressing the question: Which premorbid factors predict APB in a sample of 84 demented institutionalized elders? This was a cross-sectional descriptive study that obtained measures of the following characteristics of residents: (1) aggressive behavior as assessed by nursing home staff members using the Ryden Aggression Scale, (2) premorbid personality traits as assessed by a member of the resident's family using the NEO Five Factor Inventory and (3) history of psychosocial stress as assessed by a member of the residents' family using the modified Social Readjustment Rating Scale. Of the sample of 84 residents, 44% exhibited physical aggression. Background factors in the model were not predictive of aggressive behavior in late-stage dementia, although the relation between premorbid neuroticism and physical aggression was in the predicted direction.