In 2017, it was estimated that 5.5 million Americans have been diagnosed with Alzheimer’s disease, noting that Alzheimer’s is the sixth highest cause of death in America (Alzheimer's Association, 2018). Persons with Alzheimer’s disease or dementia often experience undesirable behaviors, primarily agitation and aggression. It has been well researched and disseminated that undesirable behaviors often stem from an unmet need, such as boredom, hunger, or even the need for toileting. Cohen-Mansfield’s Unmet Needs Model states that “problem behaviors of people with dementia result from unmet needs stemming from a decreased ability to communicate those needs and to provide for oneself” (Cohen-Mansfield, Dakheel-Ali, Marx, Thein, Regier, 2015). Unfortunately, within the long-term care setting, undesirable behaviors are often remedied in a reactionary manner via the administration of an “as needed” psychotropic medication, despite that practice conflicting with the American Psychological Association (APA) guidelines. Psychotropic medication use within the elderly population can compound with age-related physical changes, such as impaired mobility and delayed excretion related to kidney impairment, to increase the overall fall risk for the elder. Arming the bedside nursing staff with the use of psychotropic medications as the only valid tool within their respective dementia care toolkit can have devastating repercussions, assisting to cause an increase in both caregiver strain and staff burnout. Work must be done to identify the unmet needs associated with the undesirable behaviors being demonstrated by persons with Alzheimer’s or dementia, developing a robust proactive assessment strategy to better facilitate the plan of care. Such work, and the subsequent development of an improved and personalized plan of care, can allow for a number of benefits, including a decrease in the undesirable behaviors experienced by the person with dementia. Additional benefits include a decreased fall risk for the elder residing in long-term care, along with an overall improved quality of life and a decrease in caregiver strain and staff burnout. The fostering of these benefits authenticates a wealth of goals for each member of the healthcare team within the long-term setting, improving the overall disparity for persons with Alzheimer's disease and dementia.
A pilot study has been developed to evaluate the effectiveness of the advance practitioner's use of the Pittsburgh Agitation Scale (PAS) within the long-term care setting. The PAS tool was conceptualized and developed in 1994 by Dr. Jules Rosen and associates. The PAS was designed to provide the caregiver an easy, yet highly effective, tool to rate agitation, based on the principle that up to 90% of individuals with moderate to severe dementia exhibit agitation (Rosen et al., 1994). While ethical concerns exist for a study administrator working with such a vulnerable population, the acknowledgement of such concerns and astute awareness of the population's needs by the study administrator can yield valuable details associated with caring for persons with dementia who experience such undesirable behaviors. For elders with Alzheimer’s or dementia residing in long-term care who exhibit agitation and aggression: Can an advanced practitioner’s weekly retrospective review of bedside nursing staff’s daily assessment using the Pittsburgh Agitation Scale (PAS) identify longitudinal behavior trends that can then be proactively managed?
