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The Pittsburgh Agitation Scale: A User‐Friendly Instrument for Rating Agitation in Dementia Patients

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There are many rating instruments designed to assess symptoms of agitation in patients with dementia. Most scales require that raters assess multiple specific behaviors over several days, limiting the use of such scales to clinical staff who have direct contact with patients but do not have the time to complete a comprehensive assessment following each period of observation. Also, scales that assess behavior over several days must rely on “secondhand” information describing behaviors not directly observed by the rater. The Pittsburgh Agitation Scale (PAS) is an easy-to-use instrument, based on direct observations of the patient, that was developed to monitor the severity of agitation associated with dementia. Interrater reliability and measures of validity have been established with clinical staff on a busy psychogeriatric inpatient unit and with research personnel in a nursing home setting.

Section snippets

METHODS

The reliability and validity of the PAS were assessed in two separate environments: an acute-care psychogeriatric unit and a chronic-care nursing facility.

Acute Care Geropsychiatry Unit

Reliability: The intraclass correlation for the four nurses using the PAS during their work on the inpatient unit was +0.82 for the PAS Total Score. For the individual items of Aberrant Vocalizations, Motor Agitation, Aggressiveness, and Resisting Care, the intraclass correlations were +0.64, +0.54, +0.63, and +0.88, respectively. Figure 1 illustrates the distribution of total PAS scores recorded for the reliability studies in both the inpatient and nursing home settings.

Validity: Interventions

DISCUSSION

The PAS has been shown to be reliable when used by clinical staff on an acute care geriatric psychiatry unit as well as by trained research staff in a nursing home. The difference in the intraclass correlations between these two settings reflects the intensity of clinical responsibility on the inpatient service, where each observer is assigned to care for 8 to 10 patients, compared to the intensive observation performed by the research technicians in the nursing home. Also, it is important to

PAS Instructions

The Pittsburgh Agitation Scale allows an observer to describe the severity of agitation in four specific behavioral dimensions: Aberrant Vocalizations, Motor Agitation, Aggressiveness, and Resisting Care. The observer uses behavioral anchors to assign the highest possible score within each behavior group. The higher score reflects more agitation.

The behavior dimensions of “aberrant vocalizations” and “motor agitation” are assessed by intensity (loudness or rapidity of movement), disruptiveness

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