Objective: Behavioral disturbances (BD) are a major clinical problem in demented patients. They increase hospital length of stay, challenge caregivers and yield social consequences. We conducted this study to determine their true incidence in a psychogeriatric university hospital.
Design: Prospective and observational study.
Materials and Methods: The occurrence of each of the 29 BD described according to the Cohen-Mansfield assessment scale during a period of 15 minutes was considered as an event. After a short training , the nursing staff of three hospital units recorded the occurrence of such events, 4 times each hour, days and nights during a full year. An external observer independently assessed 47 randomly selected working shifts, her agreement with the nursing staff evaluated with the kappa statistics exceeded 90% in most of the identified BD.
Results: During this period of observation, 18,079 hospital days of 155 patients were evaluated. The most frequent BD, purposeless wandering, occurred 14,653 times over 987 days and was expressed by 50% of the subjects. The incidence rate was 54.6 days with at least one event per 1,000 patient-days. The second one, constant help request, was observed 12,769 times, followed by shouting (7,173 events). The most frequent physical expression of aggressiveness were spitting (3,204 events) and striking (3,112 events). Graphical analysis of BD distribution over 24 hours shows which BD predominates during the night, the morning and the afternoon.
Conclusion: The high frequency recordings of BD, as defined in the Cohen-Mansfield assessment scale, is feasible and allow a systematic, objective description of their occurrence, useful for both teaching purposes and the evaluation of the effectiveness of new therapeutic method.
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