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Published on: February 8, 2019
Temporal patterns of agitation in dementia
1Research Institute on Aging of the CES Life Communities, Rockville, MD 20852, USA. cohen-mansfield@hebrew-home.org
Summary
Agitation in dementia patients peaks around 4 pm, but "sundowning" is not supported. Increased agitation in later hours affects a minority, possibly due to staff fatigue and resident tiredness.
Area of Science:
- Gerontology
- Psychiatry
- Nursing
Background:
- Agitated behaviors are common in nursing home residents with dementia.
- The phenomenon of increased agitation in the late afternoon/evening, often termed 'sundowning,' lacks consistent empirical support.
- Understanding the temporal patterns of agitation is crucial for effective care management.
Purpose of the Study:
- To investigate the temporal patterns of agitated behaviors in nursing home residents with dementia.
- To compare these patterns with those of pleasure, environmental interest, and sleep.
- To examine the validity of the 'sundowning' hypothesis.
Main Methods:
- Direct observational data collected by trained research assistants using the Agitation Behavior Mapping Instrument and Lawton's Modified Behavior Stream.
- 174 participants from 12 nursing homes were observed.
- Data analyzed to identify temporal patterns of agitation and affect.
Main Results:
- Total agitation showed a gradual increase from morning until approximately 4 pm, followed by a decrease.
- Only 26% of participants exhibited a significant increase in agitation during later hours compared to morning hours.
- Pleasure levels did not show a consistent pattern, while interest peaked during meal times.
Conclusions:
- The observed peak in agitation around 4 pm may be linked to staff fatigue and shift changes, as well as resident fatigue.
- The term 'sundowning' is not supported by the findings and should be reconsidered.
- Increased agitation in later hours is characteristic of a minority of residents, particularly those with the highest levels of agitation.
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