Agitation: Measurement, Management, and Intervention Research Sally Weinrich, Carolyn Egbert, G. Paul Eleazer, and K. Sue Haddock Strategies for controlling and managing agitation of patients in long-term care populations has been identified as a research priority. Unfortunately, there is a paucity of literature on empirically tested therapeutic interventions for agitation. This manuscript summarizes the literature related to the measurement, man- agement, and interventions for agitation and identifies a nursing research agenda for conducting research in this area. Nonpharmacological and nonrestraint in- terventions are highlighted and categorized by (1) alterations in care given, (2) environmental adaptations, and (3) behavioral approaches. Future research areas identified by the authors focus on additional types of environmental, in- terpersonal, and behavioral interventions as well as theoretical predictors of ag- itation; the influence and role of nursing personnel and caregiver; and the legal and ethical issues involved in caring for patients who manifest agitation. Copyright © 1995 by W.B. Saunders Company A GITATION AMONG older persons with de- mentia is a common patient care manage- ment problem (Taft, 1989). Physical and chemical restraints are often used as default means of patient care management, in spite of the recognition of their disadvantages (Hardin, et al., 1993; Travis & Moore, 1991; Wykle, 1993). Zimmer, Watson, and Treat (1984) documented the frequency of in- terventions for agitation used in skilled nursing facilities as psychoactive drugs (58% of the pa- tients), physical restraints (47%), reality orienta- tion (47%), and psychiatric consultation (38%). Few studies address therapeutic interventions for agitation other than chemical (pharmacological) or physical restraints (Marx, Werner, & Cohen- Mansfield, 1989). The literature focuses primarily on descriptive or correlational studies of agitation, pharmacological intervention, and/or restraints. Further study is needed to both identify and eval- uate nonpharmacological interventions (Burgener & Barton, 1991; National Institute of Nursing Re- search, 1994). The purpose of this article is to summarize the literature on issues of measure- ment, management, and interventions for agitation and to identify a nursing research agenda for ex- amining this patient care problem. DEFINITION AND CORRELATES OF AGITATION Cohen-Mansfield (1989a, pg. 101) has defined agitation as "inappropriate verbal, vocal, or motor activity that is not explained by needs or confusion per se." Cohen-Mansfield, Marx, and Rosenthal (1989a) found general restlessness, pacing, repeti- tious sentences, requests for attention, complain- ing, negativism, and cursing to be the most fre- quently exhibited agitated behaviors in a study of 408 nursing home residents. Three types of agita- tion were identified: aggressive behavior, physi- cally nonaggressive behavior, and verbally agi- tated behavior (Cohen-Mansfield, et al., 1989a). Agitation has been documented in 8% to 91% of geriatric patients (Burgio, Jones, Butler, & Engel, 1988; Chandler & Chandler, 1988; Cohen- Mansfield, et al., 1989a; Cohen-Mansfield, Werner, & Lipson, 1993; Everitt, Fields, Soume- From the Research Division, Geriatric Division, Bymes Center for Geriatric Medicine, Education, and Research, SC 29201. Address reprint requests to Sally Weinrich, PhD, RN, c., Bymes Center for Geriatric Medicine, P.O. Box 119, Re- search Departrnen~ Columbia, SC 29202. Copyright @ 1995 by W.B. Saunders Company 0083-9417/95/0905-000453.00/0 Archives of Psychiatric Nursing, Vol.IX, No. 5 (October), 1995: pp. 251-260 251