Assuntos
Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial/normas , Hipertensão/epidemiologia , Hipertensão/terapia , Relações Médico-Paciente , Idoso , Feminino , Seguimentos , Hospitais de Veteranos , Humanos , Hipertensão/economia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Atenção Primária à Saúde , Avaliação de Programas e Projetos de Saúde , Garantia da Qualidade dos Cuidados de SaúdeRESUMO
OBJECTIVE: To examine factors predicting development of aggression. METHOD: Community-dwelling patients over 60 years of age in a Veterans Affairs Medical Center who had a documented ICD-9-CM code for dementia within 12 months of screening and no other dementia codes recorded for 2 preceding years but no aggressive behavior during the 12 months preceding study initiation were assessed every 4 months for 24 months for aggression, depression, pain, patient/caregiver relationship quality (mutuality), involvement in pleasant events, and caregiver burden. The study was conducted from September 5, 2003, to June 10, 2005. RESULTS: Of 215 patients, 89 (41%) developed aggression. In individual models, high baseline mutuality decreased risk of aggression; high burden and pain increased risk. Increases in depression and pain and declines in total mutuality also increased risk. In a full model and step-wise model, high levels of baseline caregiver burden, worst pain, and decline in mutuality over time increased risk of aggression. CONCLUSIONS: Many dementia patients become aggressive. Higher levels of worst pain, caregiver burden, and declining mutuality over time increase risk of aggression.
Assuntos
Agressão/psicologia , Doença de Alzheimer/psicologia , Demência/psicologia , Idoso , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/epidemiologia , Cuidadores/psicologia , Estudos de Coortes , Efeitos Psicossociais da Doença , Estudos Transversais , Demência/diagnóstico , Demência/epidemiologia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Relações Familiares , Seguimentos , Hospitais de Veteranos , Humanos , Incidência , Estudos Longitudinais , Pessoa de Meia-Idade , Modelos Psicológicos , Dor/diagnóstico , Dor/epidemiologia , Dor/psicologia , Estudos Prospectivos , Fatores de Risco , Meio SocialRESUMO
This study examined aggression as a predictor of nursing-home placement, injuries, use of restraints, and use of health services in community-dwelling patients with newly diagnosed dementia. Participants were identified from 2001-2004 Veterans Administration databases; all had a new diagnosis of dementia and no aggression. Patients and caregivers were evaluated for aggression, using the Cohen-Mansfield Agitation Inventory-aggression subscale, and other outcomes for 2 years, with outcome rates compared between patients who did or did not develop aggression and between pre- and postaggressive periods. Of 215 patients, 88 became aggressive, associated with significantly increased use of psychotropic medication (p< or =0.04), injuries (p< or =0.0001), and nursing-home placement (p< or =0.004).
