The Use of the Cohen‐Mansfield Agitation Inventory in the Assessment of Behavioral Disorders in Nursing Homes

ehavioral disorders are common among residents of nursB ing homes. In a study’ of 1139 elderly subjects from skilled nursing facilities, 64.2% were found to have a behavioral disturbance, 41.6% being classified as moderate and 22.6% as serious disturbances. In an Australian study a behavioral disturbance was reported in 47% of 301 patients recommended for nursing home care. Ouslander et aL3 listed behavior problems that are commonly seen in nursing home residents. “Disruptive” behaviors included shouting, breaching the privacy of others, and deliberately trying to interfere with staff activities. “Demanding” behaviors included food refusal and continuous seeking of reassurance. “Offensive” behaviors were characterized by verbal abuse, undressing in public and sexually inappropriate behavior, and “distressful” behaviors included hitting, biting, and crying. Cohen-Mansfield et aL4.’ considered many of these disturbed behaviors to be forms of agitation and subsequently developed the Cohen-Mansfield Agitation Inventory (CMAI), which can be used in identifying the nature and frequency of specific behaviors. Cohen-Mansfield et aL6 stated that they used the term “agitation” rather than “disruptive behavior” because the former was used more commonly by professionals involved in long-term care for older persons. In their definition of agitation, they referred to inappropriate verbal, vocal, or motor activity that is not explained by needs or confusion per se. Reliable quantification of behavior is desirable to facilitate documentation of symptoms, provide a tool for follow-up of behavioral changes over time, and enable researchers to measure the effects of behavioral and pharmacological interventions.’ We included the CMAI and the Rating Scale for Aggressive Behavior in the Elderly (RAGE)’ in our assessments of a nursing home population because of their comprehensiveness and to enable comparison of results with the considerable body of data already obtained using these scales. The CMAI provides caregiver ratings of 29 operationally defined observable behaviors, each rated on a 7-point frequency scale (1 = never; 7 = several times an hour), for a 2-week rating period. Although Cohen-Mansfield et al. provide instructions regarding 29 agitated behaviors, there are in