[Causes and consequences of elderly's agitated and aggressive behavior]. / Causes et retentissements des états d'agitation et d'agressivité du sujet âgé.

ABSTRACT

Agitation and aggressiveness are frequent in the elderly and often related to dementia. As a result of the ageing of the general population this is becoming a major public health concern. No or little epidemiological data, during primary health care, about symptoms, co-morbidity, nor medical and social consequences of elderlys' disruptive behavior have been gathered or published in the French literature. Thus, in order to describe these disorders, a survey in cooperation with general practitioners (GP) was conducted. A representative sample of 212 French GP's, all with preferential geriatric activity were asked to conduct a study by including retrospectively their two most recent patients older than 65, who had exhibited agitation and/or aggressiveness. From this cross sectional study, 410 patients (female 61%, male 39%) were included. The mean age was 81 years (sd 7.65). The patients suffered from change in verbal behavior (80%), verbal aggressiveness (71%), physical agitation (60%), wandering (48%), and/or physical aggressiveness (31%). The average of disruptive behavior symptoms per patient was 2.9. The symptoms appeared progressively in 81% of patients, the mean duration was two years and it was the first episode in 40% of patients. Disruptive behaviors may be explained in view of organic illness in 62% of patients (cardiovascular disease 37%, neurologic 12%, diabetes 7%, dehydratation 5%), dementia (Alzheimer disease 20%, vascular dementia 18%, mixed dementia 14%). In 54% of patients disruptive behavior may be explained in view of depression 34%, and anxiety disorder 31%. A triggering factor was observed in 57% of cases (psychosocial stress 39%). Somatic consequences of the symptoms were frequently identified decrease of alimentary intake 39%, weight loss 27%, dehydratation 11%, falls 32%, and irregular medication intake 31%. Limitation of daily life activities 85%, and family life 97% were also noted. Acceptability of patient's symptoms by the family was good (no discomfort or transitory and mild irritability) in 61% of cases, and very bad (reactions of exhaustion, hospitalization requirement) in 13%. This study carried out during primary care, showed that the elderly's disruptive behaviors cause severe medical consequences and familial and social distress.