Eight agitated residents from an Alzheimer's unit of a 500-bed skilled nursing home facility were observed over a period of two months. A behavior-mapping instrument yielded information about agitated behaviors, and the physical and social environment in which they occurred. Trained observers rated each resident's behavior for three minutes of each hour of the 24-hour day. The agitated behaviors which occurred most frequently were: making strange noises (babble, cry, scream, inappropriate laughter), constant requests for attention (repeat words, ask questions, ask for help), and repetitious mannerisms. The amount and types of agitated behaviors varied greatly across subjects and time. Some of the subjects exhibited behaviors with uniformly high frequencies during all their waking hours. While two of the eight residents appeared to manifest a sundown syndrome, four residents manifested agitation significantly more frequently during the morning hours, and the data of two residents did not show any clear pattern. These results suggest the need for reevaluation of the concept of sundown syndrome in agitated nursing home residents.
K E Y worn-Sundown syndrome, Alzheimer's disease, agitation, behavior-mapping instrument, dementia, elderly, nursing home.