A review of measures of three common dementia-related behaviors: Rejection of care, aggression, and agitation

• Published in: Geriatric nursing (New York) Vol. 41; no. 6; pp. 692 - 708
• Main Authors: Choi, Scott Seung W., Cajita, Maan Isabella, Gitlin, Laura N.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2020
• Subjects: Behavioral symptoms; Dementia measures; Nursing; Rejection of care; Dementia measures; Behavioral symptoms; Rejection of care
• ISSN: 0197-4572; 1528-3984
• DOI: 10.1016/j.gerinurse.2020.04.003

•Rejection, aggression, and agitation are measured in most dementia scales.•Yet their operationalization is highly variable.•These behaviors are not typically distinguished from each other.•Different terms are employed across measures for the same type behavior.•The varying definitions and categorizations of these behaviors is illustrative of confusion in the field and lack of attention to the role of behavioral symptoms in the disease trajectory. Clustering of behavioral symptoms in dementia is common in dementia scales. However, lack of distinction may have negative treatment implications when a treatment response differs depending on classification of behaviors. Historically, rejection of care, aggression, and agitation have been lumped together. Yet, several studies have indicated these may be conceptually different behaviors. To examine how rejection of care, aggression, and agitation are described and operationalized in existing measures of dementia-related behaviors. We identified instruments developed to measure behavioral symptoms of dementia from two existing systematic reviews. Additionally, we conducted a literature review of peer-reviewed articles published from 1980 to 2017 to identify measures that were not captured in the two previous reviews. 43 instruments developed to measure behavioral symptoms of dementia were examined. Of these, 25 (58.1%) included items related to rejection of care; 32 (74.4%) included items related to aggression; and 35 (81.4%) included agitation items. Descriptions of these behaviors were highly variable across the instruments. The review demonstrated that rejection, aggression, and agitation are measured in most scales, yet their operationalization is highly variable, and they are not typically distinguished from each other. Future efforts should be directed at developing uniform terminology to describe dementia-related behaviors while distinguishing rejection of care, aggression, and agitation in dementia scales.