German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, Witten, 58453, Germany.
Witten/Herdecke University, Faculty of Health, School of Nursing Science, Stockumer Str. 12, Witten, 58453, Germany.
BMC Psychiatry. 2021 Apr 13;21(1):191. doi: 10.1186/s12888-021-03167-5.
Severe agitation and its relation to single dimensions of quality of life are not well understood. The aim of this study was to gain more knowledge about severe agitation and to examine the relationships between the severity of agitation and single dimensions of quality of life among residents with dementia living in German nursing homes.
This exploratory secondary analysis included data from 1947 residents of 66 German nursing homes from the DemenzMonitor study. The construct of agitation was defined as a composite score of the items agitation/aggression, irritability/lability and disinhibition from the Neuropsychiatric Inventory Questionnaire (NPI-Q); the resident was classified as severely agitated if at least one of these symptoms was rated as 'severe'. The single dimensions of quality of life were measured with the short version of the QUALIDEM instrument. To avoid selection bias, two controls with mild or no agitation were selected for each resident with severe agitation using propensity score matching. Mixed linear regression models were then generated to determine the differences in the dimensions of quality of life for the severity of agitation and the defining items.
For four out of five dimensions of quality of life of the short version of QUALIDEM, residents with severe agitation had significantly lower values than residents without severe agitation. Converted to scale size, the greatest difference between both groups was found in the dimension social isolation with 23.0% (-2.07 (95% CI: -2.57, -1.57)). Further differences were found in the dimensions restless tense behaviour with 16.9% (-1.52 (95% CI: -2.04, -1.00)), positive affect with 14.0% (-1.68 (95% CI: -2.28, -1.09)) and social relations with 12.4% (-1.12 (95% CI: -1.54, -0.71)).
Severe agitation is a relevant phenomenon among nursing home residents with dementia and is associated with lower values of quality of life in the dimensions social isolation, restless tense behaviour, positive affect and social relations from the QUALIDEM instrument. Therefore, more attention should be paid to severe agitation in nursing practice and research. Moreover, care strategies used to reduce severe agitation should be considered in terms of their impact on the dimensions of quality of life.
严重激越及其与生活质量单一维度的关系尚不清楚。本研究的目的是更多地了解严重激越，并研究居住在德国养老院的痴呆症患者的激越严重程度与生活质量单一维度之间的关系。
本探索性二次分析纳入了来自 DemenzMonitor 研究的 66 家德国养老院的 1947 名居民的数据。激越的结构定义为神经精神疾病问卷（NPI-Q）中激越/攻击、易怒/易变和失抑制项目的综合评分；如果这些症状中的至少一项被评为“严重”，则将居民归类为严重激越。生活质量的单一维度使用 QUALIDEM 仪器的简短版本进行测量。为了避免选择偏差，对于每个严重激越的居民，使用倾向评分匹配选择了两个轻度或无激越的对照者。然后生成混合线性回归模型，以确定激越严重程度和定义项目的生活质量维度的差异。
对于 QUALIDEM 简短版本的五个生活质量维度中的四个维度，严重激越的居民的得分明显低于没有严重激越的居民。转换为量表大小，两组之间最大的差异出现在社会隔离维度，为 23.0%（-2.07（95%CI：-2.57，-1.57））。在不安紧张行为维度还发现了进一步的差异，为 16.9%（-1.52（95%CI：-2.04，-1.00））、积极影响维度为 14.0%（-1.68（95%CI：-2.28，-1.09））和社会关系维度为 12.4%（-1.12（95%CI：-1.54，-0.71））。
严重激越是痴呆症养老院居民的一个相关现象，与 QUALIDEM 仪器的社会隔离、不安紧张行为、积极影响和社会关系维度的生活质量值较低有关。因此，在护理实践和研究中应更加关注严重激越。此外，应考虑用于减少严重激越的护理策略对生活质量维度的影响。
