Behavioral characteristics of agitated nursing home residents with dementia at the end of life.
OBJECTIVE
The purpose of this study was to examine group differences in verbal agitation, verbal interaction, bed restraint, pain, analgesic and neuroleptic medication use, and medical comorbidity among agitated nursing home residents who died during a 6-month clinical trial compared with residents of the same gender and similar initial cognitive status who did not die during the trial.


METHODS
We conducted a two-group secondary data analysis of prospective observational data from 10 nursing homes in Birmingham, Alabama. By means of chart review, resident assessments, surveys of certified nursing assistants, and direct observation of residents' daily behaviors and environment, 32 residents (87.34 +/- 7.29 years) with a Mini-Mental State Examination (MMSE) score = 4.31 (+/-5.54) who died were compared with 32 residents (84 +/- 6.96 years) with a mean MMSE score = 4.28 (+/-5.49) who did not die during the clinical trial.


RESULTS
Residents who died displayed more verbal agitation, less time in verbal interaction with staff, and almost twice as much time restrained in bed during observation time in comparison with residents who did not die during the clinical trial. However, groups did not differ significantly in severity of comorbid illness, functional status, number of painful diagnoses, certified nursing assistants' reports of residents' pain, or opioid or nonopioid analgesic prescription or dosage. Surviving residents were more likely to receive neuroleptic medication than residents who died.


CONCLUSIONS
Results suggest that agitated nursing home residents may exhibit a heightened level of verbal agitation, decreased verbal interaction with staff, and increased bed restraint up to 3 months prior to death. Prospective observational studies are needed to identify markers for imminent mortality among nursing home residents.
Allen
Rebecca S
RS
Department of Psychology, The University of Alabama, Tuscaloosa, 35487-0315, USA. rsallen@bama.ua.edu
Burgio
Louis D
LD
Fisher
Susan E
SE
Michael Hardin
J
J
Shuster
John L
JL
D000203:Activities of Daily Living / Q000523:psychology*; D000369:Aged, 80 and over; D000407:Alabama; D000700:Analgesics / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001519:Behavior; D015897:Comorbidity; D003704:Dementia / Q000453:epidemiology*; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010146:Pain / Q000517:prevention & control; D011595:Psychomotor Agitation / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D012149:Restraint, Physical; D013727:Terminal Care; D014705:Verbal Behavior
D000700:Analgesics; D014150:Antipsychotic Agents