Study Suggests Aggression is Common among Veterans with Dementia
Aggressive behavior negatively affects caregivers, increases expenses, and has negative consequences for patients with dementia, including institutionalization, as well as injuries to self and others. However, the relationship between aggression and specific outcomes has not been conclusively determined. The purpose of this longitudinal study was to assess rates of nursing-home placement, injuries, use of restraints, and use of health services in community-dwelling Veterans with dementia who develop aggression compared with those who do not. Investigators identified 215 Veterans who received VA outpatient treatment from 2001 to 2004, and who were newly diagnosed with non-aggressive dementia. Aggressive behavior was assessed over the 24-month study period through home visits and telephone assessments with caregivers. Investigators also examined the use of anxiolytics or antipsychotics.
Findings showed that 88 (41%) of the Veterans became aggressive within 24 months, corroborating the findings of previous studies that aggression is common in persons with dementia. The use of antipsychotic medications increased significantly in Veterans after they became aggressive, and this group also had a ten-fold greater occurrence of injuries. In addition, 10 aggressive Veterans with dementia were admitted to nursing homes, almost twice as many as non-aggressive Veterans. There were no differences in rates of restraint use or in- and outpatient visits between Veterans who became aggressive and those who did not from the pre- to post-aggressive periods. The authors suggest that interventional studies aimed at preventing aggression have great potential to reduce patient and caregiver suffering, side-effects of medications used to treat aggression, as well as risk of injury to patients and loved ones.
Kunik M, Snow A, Davila J, et al. Consequences of Aggressive Behavior in Patients with Dementia. Journal of Neuropsychiatry and Clinical Neurosciences Winter 2010;22(1):40-47.
This study was supported by HSR&D (IIR 01-159). Drs. Kunik, Snow, and Davila are part of HSR&D's Houston Center for Quality of Care and Utilization Studies.
