VA Study Identifies Consequences of Aggression in Dementia Patients
HOUSTON - In a study published March 2010 in The Journal of Neuropsychiatry and Clinical Neurosciences, Mark Kunik, M.D., M.P.H., a psychiatrist at the Michael E. DeBakey VA Medical Center, and his colleagues reported results of research underscoring the importance of effectively treating aggression in individuals with dementia.
“This study confirms findings of earlier studies that aggression is common in persons with dementia,” said Kunik, primary author of the article. “Perhaps even more importantly, it underscores the importance of early diagnosis and effective treatment of aggression as a means of preventing or minimizing consequences such as injuries, use of psychiatric medications, and nursing-home placement; all of which can have a profound impact on an individual’s quality of life.”
The study is part of an effort examining aggression in 215 community-dwelling, over the age of 60, mostly male patients who have been diagnosed with aggression in the past year. The researchers found the 88 patients who became aggressive had significantly increased use of psychiatric medications, injuries, and nursing-home placement.
Patients and caregivers were evaluated monthly for aggression for two years. The researchers compared the patients who did and did not develop aggression. For the patients who did, the researchers examined the time before and after they developed aggression.
“Almost twice as many aggressive as nonaggressive patients were admitted to nursing homes,” said Kunik. “This is important because effective treatment could perhaps prevent this consequence. More research is needed in this area.”
Other findings included that patients who became aggressive had a 10-fold increase in rate of injuries to themselves and caregivers, and a significantly increased use of psychotropic medications. The latter is important because of these drugs’ limited effectiveness and risks for elderly patients, who often must take a wide range of medications and are also vulnerable to falls, fractures, and dizziness.
The study breaks new ground by analyzing individuals living in the community, rather than in nursing homes, and by considering dementia patients with a new diagnosis of aggression, rather than those with well-established dementia. The article emphasizes the need for further research to prevent aggression and its consequences, thus reducing the suffering of both patients and caregivers, minimizing the side-effects of medications, and reducing the risk of injury to patients and their loved ones.
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