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 noncompliance 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.