A descriptive study of physically aggressive behavior in dementia by direct observation.

OBJECTIVE

To study, by direct observation, physically aggressive behavior (PAB) in a cohort of older persons with dementia.

DESIGN

Cross-sectional survey.

SETTING

A locked special care unit for Alzheimer's Disease and an ordinary skilled unit of two suburban nursing homes.

PARTICIPANTS

Twenty men and women with a history of PAB.

MEASUREMENTS AND MAIN

RESULTS

Portable bar-code-readers and daily diaries were used to determine the frequency of PAB as well as to elucidate the antecedents and consequences of it. PAB was most often directed toward staff (23/28 episodes), usually in the context of personal care (15/23 episodes). In the majority of cases, verbal aggression or non-compliance preceded the PAB. Most often PAB was followed by a rapid return to non-aggressive behavior.

CONCLUSIONS

Very little PAB was truly spontaneous, nor was it usually the participant's normal behavior. Most PAB occurred in response to intrusion into the participant's personal space by staff or other residents. The PAB is better understood as a defensive response than an expression of anger.