Objective:

The purpose of this study is to examine the relationship of physical space to agitation in long-term care facility residents with moderate to severe dementia.

Design:

This descriptive comparative study is a secondary analysis of a sample of 2544 units of 15-minute time periods from the study titled “Affect of the BACE intervention on agitation and resistiveness to care (BACE)” by Christine R. Kovach, Ph.D. RN. Data on agitation, time of day, location, in addition to demographic data from the above mentioned study was used.

Materials and Methods:

For the purposes of this study, a convenience sample of 53 participants, who met certain eligibility criteria, residing in 6 nursing homes were employed.

The two main variables for this study were agitation and location; time of day was an interaction variable. Information was recorded at every 15-minute interval from 8:00 a.m. to 8:00 p.m.

Agitation was assessed through the use of a Visual Analog Scale (VAS) that covered a range of 0 to 100. Higher scores indicated greater agitation.

Specific information on location was collapsed and described as private, activity, or transitional space. For the purposes of this study time of day was divided into morning, afternoon, and evening.

Results:

To assess the agitation level of people with dementia in various settings, frequencies of their agitation scores were tabulated by location. High agitation was frequently observed at nurses’ stations (60%), corridors (47.74%), activity rooms (36.25%), and bedrooms (34.38%). In dining areas high agitation was uncommon (21%).

A chi-square test of independence was calculated comparing agitation level for location. A significant difference was found (c²(8)=50.43, p<.01). High agitation was observed more often in transitional spaces (49.3%), than in activity (29.5%), or private (33.4%) spaces.

A second chi-square test of independence was calculated comparing agitation level for each location at three different times. A significant difference was found for all settings: private ( c²(8)=16.90, p<.05), activity (c²(8)=41.50, p<.01), and transitional (c²(8)=23.12, p<.01). An increase in agitation throughout the day was observed in activity and transitional spaces, and a decrease in agitation was observed in private spaces.

Conclusion:

This study suggests that, agitation in nursing home residents with severe dementia is related to physical space. Higher agitation scores were recorded more often in transitional spaces, than in activity, or private spaces. Low agitation was prevalent specifically in dining areas.

Agitation in private, activity and transitional spaces was found to be significantly dependent on time. An increase in agitation was observed throughout the day for activity and transitional spaces; whereas, a decrease was noted for private spaces.

Future examination is needed of specific characteristics of environments that possibly instigate agitation.