The relationship between linguistic communication skills and physically aggressive behavior in nursing home residents with possible dementia of the Alzheimer's type

Abstract

Physically aggressive behavior (PAB) is any hostile action physically directed toward other persons or objects or towards the self. The definitive cause of PAB is unknown but there is empirical evidence suggesting internal factors such as cognitive status and/or external factors within the nursing home environment play an important role. As cognitive status decreases, there is deterioration in linguistic communication (L-C) ability. Although there is some preliminary evidence indicating a possible association between PAB and L-C ability, no previous studies have investigated the association between PAB and L-C ability in a population of patients with Alzheimer's disease. This study was designed to explore the relationship between linguistic communication (L-C) and physically aggressive behavior (PAB) in sixty nursing home residents with possible Alzheimer's dementia. Instruments included the language subscale of the Neurobehavioral Cognitive Status Examination and the PAB subscale of the Ryden Aggression Scale, Forms 1 (retrospective) and 2 (concurrent). The Interaction Behavior Measure (ISM) was used to measure caregiver interaction behavior, a confounding variable related to PAB. After L-C ability was measured by the investigator, each subject was observed during bathing and dressing care routine on either the day or evening shift by a research assistant blind to the research hypothesis. Simultaneously, the caregiver interaction behavior was documented using the IBM. Only 7 subjects exhibited PAB during observed bathing thus the planned statistical analysis could not be conducted. Secondary analyses revealed no difference among the groups with and without PAB, measured retrospectively, on age, education, length of stay, language score, psychotropic medication use, and caregiver interaction behavior. Males and females did not differ on amount of PAB. Among cognitive status, ADL ability, and number of medical diagnoses, only number of diagnoses was related to PAB. Findings related to differences among the IBM subscales indicated that task orientation in nursing assistants may be associated with decreased verbal banter.