Potential Risk Factors Indicating the Likelihood of Aggression and Violence in Individuals with Dementia: a Systematic Review

    Student thesis: Master's Thesis


    BACKGROUND: Aggression in individuals with dementia is a common behavioural symptom of the disorder, and has been found to be the most reported source of caregiver distress, and the main reason why an individual will be placed in residential care.
    OBJECTIVES: To establish the factors which can predict an episode of aggression in individuals living with dementia.
    DESIGN: Eleven bibliographic databases, the references retrieved from articles, two protocol databases and one thesis database were systematically reviewed for factors with a relationship with subsequent aggressive behaviour in individuals living with dementia.
    SETTINGS: Care/residential/nursing homes, hospitals, secure units and domestic settings.
    PARTICIPANTS: Individuals who have been diagnosed with dementia, including Alzheimer’s disease, vascular dementia, dementia with Lewy bodies, fronto-temporal dementia and mixed dementia with a mean age of over 65.
    MEASUREMENTS: Indicators preceding an episode of aggression or violence in patients with dementia. Predicting factors included (but were not limited by) demographic details (may include gender, occupation, ethnic group, marital status, age, education), illnesses (may include psychiatric and/or physical illness, pain, side effects of medication), type of environment (may include environmental stimuli, change in surroundings, routine or activity levels) and relationships with other people (may include relationship with carers, carer’s behaviour).
    RESULTS: Fifty-five articles met the entry criteria. Overall they investigated 52 different factors which were found to have an impact (or no impact) on aggression in people living with dementia. These were grouped into eight overarching categories (Comorbid Mental Health, Demographic Data, Facility Characteristics, Health Issues, Communication/interaction with Caregiver, Mood/Personality, Direct effects of Dementia and Caregiver Features). The data was not sufficiently homogenous to enable a meta-analysis. A systematic narrative review was carried out which found that psychosis, personal care events, non-compliance of the individual, pre-morbid personality and communication issues were found to have the strongest relationship to the onset of aggression. Level of education and the type of dementia were found to have the least impact on an act of aggression being displayed.
    CONCLUSION: The results showed a variety of factors having an impact on levels of aggression of those living with dementia. These findings warrant the development of a measurement tool to predict aggression which incorporates the complex social, psychological and physical interactions identified.
    Date of Award15 Dec 2016
    Original languageEnglish
    SupervisorGareth Roderique-Davies (Supervisor)

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