title: Factors associated with aggressive behavior among nursing home residents with dementia.
abstract: OBJECTIVE
  In an attempt to more thoroughly describe aggressive behavior in nursing home residents with dementia, we examined background and proximal factors as guided by the Need-Driven Dementia-Compromised Behavior model.
  
  
  METHODS
  We used a multivariate cross-sectional survey with repeated measures; participants resided in nine randomly selected nursing homes within four midwestern counties. The Minimum Data Set (with verification by caregivers) identified participants. We used a disproportionate probability sample of 107 participants (51% with a history of aggressive behavior) to ensure variability. Videotaped care events included four of direct care (shower baths, meals, dressing, and undressing) and two of nondirect care (two randomly selected 20-minute time periods in the afternoon and evening). The majority of participants (75%) received three shower baths, for a total of 282 videotaped baths.
  
  
  RESULTS
  Because the shower bath was the only care event significantly related to aggressive behavior (F = 6.9, p < .001), only those data are presented. Multilevel statistical modeling identified background factors (gender, mental status score, and lifelong history of less agreeableness) and a proximal factor (amount of nighttime sleep) as significant predictors (p < .05) of aggressive behavior during the shower bath. We found significant correlations between aggressive behavior and negative subject affect (r = .27) during the bath, and aggressive behavior and lifetime agreeableness level (r = -.192). We also found significant correlations between mental status and the amount of education (r = .212), and between negative caregiver affect and negative participant affect (r = .321).
  
  
  CONCLUSIONS
  We identified three background and one proximal factor as significant risk factors for aggressive behavior in dementia. Data identify not only those persons most at risk for aggressive behavior during care, but also the care event most associated with aggressive behavior. Together these data inform both caregiving for persons with dementia as well as the design of intervention studies for aggressive behavior in dementia.
authors.affiliation: University of Michigan School of Nursing, Ann Arbor, MI 48109-0482, USA. annwhall@umich.edu
authors.forename: Ann L
authors.initials: AL
authors.lastname: Whall
authors.forename: Kathleen B
authors.initials: KB
authors.lastname: Colling
authors.forename: Ann
authors.initials: A
authors.lastname: Kolanowski
authors.forename: HyoJeong
authors.initials: H
authors.lastname: Kim
authors.forename: Gwi-Ryung
authors.initials: GR
authors.lastname: Son Hong
authors.forename: Barry
authors.initials: B
authors.lastname: DeCicco
authors.forename: David L
authors.initials: DL
authors.lastname: Ronis
authors.forename: Kathy C
authors.initials: KC
authors.lastname: Richards
authors.forename: Donna
authors.initials: D
authors.lastname: Algase
authors.forename: Cornelia
authors.initials: C
authors.lastname: Beck
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression / Q000523:psychology*; D003430:Cross-Sectional Studies; D003704:Dementia; D005260:Female; D006801:Humans; D008297:Male; D015146:Midwestern United States; D008960:Models, Psychological; D009735:Nursing Homes; D014743:Videotape Recording