Agitation in dementia: concept clarification.
OBJECTIVE
The aim of this paper is to clarify the concept of agitation in dementia through analysing definitions, critical attributes, components, boundaries, antecedents and consequences of agitation.


BACKGROUND
The concept of agitation is not well defined. In addition, there exists much confusion about the characteristics and boundaries of agitation, as well as the distinction between agitation and related concepts. Recently developed theoretical models for agitation in dementia require new interpretation and conceptualization of agitation.


METHODS
Morse's method of critical appraisal of the literature was used. In addition, some parts of Rodgers' evolutionary method were employed. Data were selected using six electronic databases and the key words 'agitation', 'agitated', 'dementia', 'demented' and 'Alzheimer'. The analysis included 86 empirical or theoretical papers and one book.


RESULTS
A transition from the observer's perspective to the patient's perspective in the interpretation of agitation was found. Five critical attributes of agitation in dementia were identified: excessive, inappropriate, repetitive, non-specific and observable. Patient factors, interpersonal factors, environmental factors and restraint were identified as precipitating antecedents. Mediating antecedents included discomfort, unmet need and misinterpretation. Consequences of agitation were identified at the levels of patient, caregiver and others.


CONCLUSIONS
This transition in perspectives has important implications as it can change health providers' attitudes and responses to agitation and lead to patient-focused and individualized care. Researchers and clinicians are encouraged to avoid labelling agitated behaviour as 'disturbing behaviour'.
Kong
Eun-Hi
EH
School of Nursing, University of Pennsylvania, Philadelphia, PA 19104-6106, USA. ehkong@nursing.upenn.edu
D000374:Aggression / Q000523:psychology*; D001291:Attitude of Health Personnel; D003704:Dementia / Q000150:complications* / Q000523:psychology; D006801:Humans; D009740:Nursing Staff / Q000523:psychology; D011595:Psychomotor Agitation / Q000523:psychology*; D011795:Surveys and Questionnaires