Journals of Gerontology Series A: Biological Sciences and Medical Sciences, Vol 53, Issue 1 M65-M71, Copyright © 1998 by The Gerontological Society of America
Longitudinal changes in behavioral problems in old age: a study in an adult day care population
J Cohen-Mansfield and P Werner
Research Institute of the Hebrew Home of Greater Washington, USA.
BACKGROUND: Four types of agitation have been identified: physically
aggressive behaviors, physically nonaggressive behaviors, verbally
aggressive behaviors, and verbally nonaggressive behaviors. These pose a
major challenge to caregivers and are sometimes indicators of the emotional
state of the older person. Longitudinal changes in these four subtypes of
agitated behaviors were examined. METHODS: One hundred and four
community-dwelling participants of five senior day care centers (mean age =
79) were followed up for 2 years. Their agitation was assessed, as was
their cognitive functioning, affect, and medical functioning. RESULTS:
Although physically nonaggressive, physically aggressive, and verbally
aggressive behaviors increased significantly over 2 years, verbally
nonaggressive behaviors did not show significant changes over time. These
patterns can be partially explained by the relationship between the
different types of agitation and cognitive functioning. Increases in
physically nonaggressive behaviors from start to end of the 2 years were
predicted by greater cognitive impairment at baseline and by receiving a
smaller number of medications at baseline. Increases in verbally aggressive
behaviors and in physically aggressive behaviors during the study period
correlated significantly with a greater decline in cognitive functioning
and increased depression at baseline. In addition, increases in physical
aggression were correlated with greater cognitive impairment at baseline.
CONCLUSIONS: The course of change for each type of agitation was unique.
The relationships between inappropriate behaviors, cognitive functioning,
physical health, and depression over time are complex and vary by type of
agitation.
