Longitudinal changes in behavioral problems in old age: A study in an adult day care population

Background. Four types of agitation have been identified: physically aggressive behaviors, physically nonaggressive behaviors, verbally aggressive behaviors, and verbally nonaggressive behaviors. These pose a major challenge to caregivers and are sometimes indicators of the emotional state of the older person. Longitudinal changes in these four subtypes of agitated behaviors were examined. Methods. One hundred and four community-dwelling participants of five senior day care centers (mean age = 79) were followed up for 2 years. Their agitation was assessed, as was their cognitive functioning, affect, and medical functioning. Results. Although physically nonaggressive, physically aggressive, and verbally aggressive behaviors increased significantly over 2 years, verbally nonaggressive behaviors did not show significant changes over time. These patterns can be partially explained by the relationship between the different types of agitation and cognitive functioning. Increases in physically nonaggressive behaviors from start to end of the 2 years were predicted by greater cognitive impairment at baseline and by receiving a smaller number of medications at baseline. Increases in verbally aggressive behaviors and in physically aggressive behaviors during the study period correlated significantly with a greater decline in cognitive functioning and increased depression at baseline. In addition, increases in physical aggression were correlated with greater cognitive impairment at baseline. Conclusions. The course of change for each type of agitation was unique. The relationships between inappropriate behaviors, cognitive functioning, physical health, and depression over time are complex and vary by type of agitation.