Association Between Engagement and Agitation in Dementia: Clinical and Environmental Factors in Nonpharmacological Therapy.

Abstract

Introduction: Agitation is a common behavioral symptom in dementia that increases caregiver burden and contributes to hospitalization or institutionalization. Nonpharmacological interventions are essential to manage agitation; however, their effectiveness has been inconsistent. A potential explanation is that engagement-defined as patients' attitudes and behaviors during therapy-has rarely been incorporated into the evaluation of these interventions. This study aimed to clarify the association between engagement and agitation and to identify related clinical and environmental factors.

Methods: This cross-sectional study included 66 hospitalized individuals with dementia (mean age 81.4±6.9 y). Assessments comprised demographics, cognitive function, activities of daily living, behavioral and psychological symptoms, environmental parameters, comorbidities, pain, and engagement. Correlation and multiple regression analyses were conducted to explore factors associated with engagement.

Results: Engagement was positively correlated with cognitive function and daily living abilities, and negatively correlated with dementia severity, pain, agitation, depression, visual impairment, and humidity. Multiple regression analysis showed engagement was independently associated with pain, dementia severity, visual impairment, and agitation.

Conclusions: Engagement in dementia was influenced by pain, dementia severity, visual impairment, and agitation. Attention to these factors, particularly pain management, may optimize nonpharmacological interventions, enhance engagement, and help reduce agitation in dementia.