Timeslips—Comparing Agitation and Anxiety Rating Scales to Evaluate the Benefit of Non-Pharmacologic Creative Sessions in Nursing Home Patients with Dementia
Open Journal of Nursing
Timeslips™ is a group storytelling program that encourages creative expression among dementia patients without the pressure to recall the past. Analysis of the literature was conducted to determine the nine most relevant agitation and anxiety scales most appropriate for use with Timeslips in nursing home patients with dementia, who experience agitation and anxiety. Qualitative assessment of the nine scales was conducted to identify six criteria to determine the most pertinent characteristics
... characteristics for implementation of Timeslips within this patient population: 1) validity/reliability, 2) observation period, 3) training required, 4) time to administer, 5) most appropriate administrator and 6) accessibility/cost. Utilizing these six criteria, quantitative assessment was conducted using the Analytical Hierarchical Process (AHP) to identify that the Overt Agitation Severity Scale (OASS) was optimal. IRB approvals have been attained to investigate use of the OASS with Timeslips in the nursing home setting for patients with dementia, who experience agitation and anxiety. The prevalence of anxiety and agitation associated with early onset dementia and Alzheimer's disease (AD) is common and affects up to 70 percent of patients   . Additionally, agitation can occur in up to 90 percent of people with moderate to severe dementia  . Both anxiety and agitation tend to increase as the disease progresses. In the case of agitation, it is most commonly characterized by repetitive mannerisms, non-loud verbal excesses, and wandering  . These non-aggressive behavioral symptoms of aggression have been reported as the most frequent forms of agitation in dementia patients  although severe cognitive deficiencies can display intense aggressive and impulsive behaviors and continue to heighten with the development of dementia disorders  . Managing agitation and difficult behavior can be the most difficult part of treating patients with AD. In anxiety, there is association with other symptoms, such as depression, behavioral disturbances and increased cognitive impairment  . This high prevalence of agitation and anxiety in AD patients has many effects on the patient as well as on the caregiver and quality of care. Agitation and aggression behaviors are often disturbing for the individual patient, provide risk to patients and others and present challenges for clinicians  .