Predictors of Behavioral and Psychological Symptoms of Dementia: Based on the Model of Multi-Dimensional Behavior

Jeong Eun Yang; Gwi-Ryung Son Hong

doi:10.4040/jkan.2018.48.2.143

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Yang and Hong: Predictors of Behavioral and Psychological Symptoms of Dementia: Based on the Model of Multi-Dimensional Behavior

Original Article

J Korean Acad Nurs 2018;48(2):143-153.

Published online: 15 January 2018

DOI: https://doi.org/10.4040/jkan.2018.48.2.143

Predictors of Behavioral and Psychological Symptoms of Dementia: Based on the Model of Multi-Dimensional Behavior

Jeong Eun Yang, Gwi-Ryung Son Hong

College of Nursing, Hanyang University, Seoul, Korea

Address reprint requests to : Hong, Gwi-Ryung Son College of Nursing, Hanyang University, 222 Wangsimniro, Seongdong-gu, Seoul 04763, Korea Tel: +82-2-2220-0701 Fax: +82-2-2295-2074 E-mail: grson@hanyang.ac.kr

Received 6 November 2017 Revised 12 February 2018 Accepted 14 February 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The purpose of this study was to identify factors predicting behavioral and psychological symptoms of dementia (BPSD) in persons with dementia. Factors including the patient, caregiver, and environment based on the multi-dimensional behavioral model were tested.

Methods

The subjects of the study were 139 pairs of persons with dementia and their caregivers selected from four geriatric long-term care facilities located in S city, G province, Korea. Data analysis included descriptive statistics, inverse normal transformations, Pearson correlation coefficients, Spearman's correlation coefficients and hierarchical multiple regression with the SPSS Statistics 22.0 for Windows program.

Results

Mean score for BPSD was 40.16. Depression (β=.42, p<.001), exposure to noise in the evening noise (β=-.20, p=.014), and gender (β=.17, p=.042) were factors predicting BPSD in long-term care facilities, which explained 25.2% of the variance in the model.

Conclusion

To decrease BPSD in persons with dementia, integrated nursing interventions should consider factors of the patient, caregiver, and environment.

Keywords: Dementia, Behavioral Symptoms, Long-Term Care, Residential Facilities

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Figure 1.

Substruction model of the theory of this study.

Table 1.

Patient Factors, Caregiver Factors and Environment Factors of the Study Participants (N=278)

Factors	Variables	Categories	n (%) or M±SD	Possible range	Actual range
Patient factors (n=139)	Age (yr)		84.64±7.14		67~100
		65~80	37 (26.6)
		81~90	76 (54.7)
		≥91	26 (18.7)
	Gender	Male	26 (18.7)
		Female	113 (81.3)
	Education level	None	30 (21.6)
		Elementary	49 (35.2)
		≥Middle	60 (43.2)
	Cognitive impairment	Yes	87 (62.6)	0~30	1~24
		No	52 (37.4)
	Functional level	Dependency (≤14)	115 (82.7)	0~20	0~20
		Independency (≥15)	24 (17.3)
	Pain		1.45±1.63	0~27	0~7
	Depression	Yes	65 (46.8)/11.60±5.11	0~38	0~28
		No	74 (53.2)/2.49±1.57
Caregiver factors	Gender	Female	139 (100.0)
(n=139)	Education level	<High school	33 (23.7)
		High school	94 (67.7)
		≥College	12 (8.6)
	Knowledge		15.26±1.93	0~20	8~19
	Depression	Yes	22 (15.8)/6.27±2.05	0~10	0~10
		No	117 (84.2)/1.08±1.01
Environment factors	Staffing ratio	<1:19	49 (35.3)
		≥1:19	90 (64.7)
	Noise level (dBA)	Morning room	53.48±3.70
		Morning lobby	60.49±2.89
		Evening room	56.00±2.64
		Evening lobby	62.81±2.51
Behavioral and	Physically aggressive behaviours		1.20±0.30^†	1~7
psychological	Physically nonaggressive behaviours		1.59±0.90^†	1~7
symptoms of	verbally agitated behaviours		1.70±0.70^†	1~7
dementia	Hiding/Hoarding behaviours		1.26±0.37^†	1~7
	Total		40.16±11.17^†	29~203	29~84

dBA=Decibel with A-weighting; M±SD=Mean standard deviation; yr=Year.

^†Rank-inverse-normal transformed data.

Table 2.

Correlation among Patient Factors, Caregiver Factors and Environment Factors (Unit of analysis=139)

Factors	Variables	Behavioral and Psychological Symptoms of Dementia
		Total	Physically aggressive	Physically non-aggressive	Verbally agitated	Hiding/Hoarding
		r (p)	r (p)	r (p)	r (p)	r (p)
Patient factors	Gender	−.18 (.036)	−.19 (.024)	−.18 (.034)	−.15 (.080)	−.03 (.734)
	Education level^†	−.09 (.290)	−.05 (.569)	−.04 (.641)	−.14 (.107)	−.06 (.517)
	Cognitive impairment	.06 (.484)	.06 (.456)	.04 (.628)	.01 (.936)	−.01 (.876)
	Functional level	−.02 (.815)	.05 (.560)	−.08 (.340)	−.07 (.423)	−.21 (.015)
	Pain	−.04 (.649)	−.05 (.594)	.04 (.624)	−.06 (.475)	−.05 (.569)
	Depression	.48 (<.001)	.29 (.001)	.41 (<.001)	.49 (<.001)	.25 (.003)
Caregiver factors	Education level^†	−.05 (.954)	−.01 (.934)	−.02 (.800)	−.04 (.639)	−.06 (.462)
	Knowledge	−.10 (.262)	−.13 (.129)	−.13 (.117)	.01 (.930)	−.15 (.088)
	Depression	−.13 (.122)	−.13 (.133)	−.11 (.189)	−.05 (.542)	.12 (.152)
Environment Factors	Staffing ratio	−.06 (.474)	−.05 (.528)	−.06 (.461)	−.06 (.515)	−.02 (.860)
	Morning noise level (dBA)	.05 (.569)	.12 (.179)	.07 (.433)	.10 (.257)	−.02 (.839)
	Evening noise level (dBA)	−.26 (.002)	−.14 (.112)	−.20 (.022)	−.23 (.008)	−.03 (.713)

dBA=Decibel with A-weighting.

^†Spearman correlation coefficients.

Table 3.

Predictors of Behavioral and Psychological Symptoms of Dementia (Unit of analysis=139)

Factors	Variables	Model 1					Model 2
		B	S.E.	β	t	p	B	S.E.	β	t	p
Non-modifiable factors
Patient factors	Gender^†	.25	.10	.23	2.52	.013	.18	.09	.17	2.05	.042
	Education level	−.11	.07	−.20	−1.64	.105	−.07	.06	−.13	−1.17	.243
	Cognitive impairment	^‡ -.06	.11	−.07	−0.55	.585	−.07	.09	−.08	−0.79	.433
	Functional level^§	.02	.10	.02	0.23	.822	−.06	.09	−.06	−0.68	.496
Caregiver factors	Education level	−.01	.07	−.01	−0.12	.906	.02	.06	.03	0.36	.718
Environment factors	Staffing ratio^‖	−.03	.08	−.03	−0.38	.707	.06	.07	.06	0.81	.422
Modifiable factors
Patient factors	Depression^¶						.38	.07	.42	5.25	<.001
	Pain						−.02	.02	−.07	−0.90	.368
Caregiver factors	Depression^¶						−.16	.10	−.14	−1.67	.097
	Knowledge						−.01	.02	−.03	−0.39	.696
Environment factors	Evening noise level (dBA)						−.04	.02	−.20	−2.50	.014
		Adj. R²=.02, F=1.38, p=.229					Adj. R²=.25, F=5.23, p<.001

Adj.=Adjust; dBA=Decibel with A-weighting; S.E.=Standard error.

^†Dummy variable (Male=0, Female=1); ^‡dummy variable (No=0, Yes=1); ^§dummy variable (Independent=0, Dependent=1); ^‖dummy variable (<1:19=0, ≥1:19=1); ^¶dummy variable (No=0, Yes=1).

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