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The rating scale for agitation
Definition
The The Cohen-Mansfield agitation inventory (CMAI) was developed for use in the nursing home to assess the frequency of manifestations of agitated behaviors in elderly persons.
It has been used also by family caregivers, social workers, activity directors of senior day care centers and others.
The CMAI may be self-administered by a caregiver or it may be completed by interviewing a staff of family caregiver.
Scoring
The CMAI (long form)* consists of 29 agitated behaviors, each rated on a 7-point scale of frequency. Ratings pertain to the two weeks preceding the administration of the CMAI.
*In addition to the long form of the CMAI, there are other versions of the CMAI:
1. Short form - Only 14 agitated behavior categories are included, each rated on a 5-point
frequency scale instead of a 7-point frequency scale.
2. Community form (CMAI-C) - this 37-item questionnaire has been used with formal and informal caregivers of community-dwelling elderly persons in a longitudinal study of agitation.
3. Disruptiveness form - The disruptiveness of each behavior is rated along with frequency.
The rating scale for the agitated behaviors is as follows:
1 point - Never
2 points - Less than once a week but still occurring
3 points - Once or twice a week
4 points - Several times a week
5 points - Once or twice a day
6 points - Several times a day
7 points - Several times an hour
This scale relies on subjective information given by the rater.
Calculating agitation scores: The CMAI contains a diversified group of behaviors. For analysis
purposes, it is not useful to calculate a total score by adding all the categories. Analysis can pertain
to either specific behaviors of interest, or each of the three factors of agitation described below (see
section on psychometric properties). However, researchers may want to do their own factor
analysis because factors depend on the population studied. Another possibility is to weigh
behaviors according to their disruptive impact and then combine them accordingly.
Criteria for agitated/not agitated status:The criteria we used were:
Aggressive behavior occurring at least several times a week, i.e.,
at least one aggressive behavior occurring at a frequency of 4
or at least two aggressive behaviors occurring at a frequency of 3
or at least three aggressive behaviors occurring at a frequency of 2
or two aggressive behaviors occurring at a frequency of 2 and one at a frequency of 3
Physically nonaggressive behavior occurring at least once a day, i.e.,
at least one physically nonaggressive behavior occurring at a frequency of 5
or least two physically nonaggressive behaviors occurring at a frequency of 4
or least three physically nonaggressive behaviors occurring at a frequency of 3
or least four physically nonaggressive behaviors occurring at a frequency of 2
Verbally agitated behavior occurring at least once a day, i.e.,
at least one verbally agitated behavior occurring at a frequency of 5
or least two verbally agitated behaviors occurring at a frequency of 4
or least three verbally agitated behaviors occurring at a frequency of 3
or least four verbally agitated behaviors occurring at a frequency of 2
The questionnaire
Please read each of the 29 agitated behaviors, and circle how often (from 1-7) each was manifested by the resident during the last 2 weeks:
Item 1. Pace, aimless wandering (1, 2, 3, 4, 5, 6, or 7 points)
Item 2. Inappropriate dress or disrobing
Item 3. Spitting (include at meals)
Item 4. Cursing or verbal aggression
Item 5. Constant unwarranted request for attention or help
Item 6. Repetitive sentences or questions
Item 7. Hitting (including self)
Item 8. Kicking
Item 9. Grabbing onto people
Item 10. Pushing
Item 11. Throwing things
Item 12. Strange noises (weird laughter or crying)
Item 13. Screaming
Item 14. Biting
Item 15. Scratching
Item 16. Trying to get to a different place (e.g., out of the room, building)
Item 17. Intentional falling
Item 18. Complaining
Item 19. Negativism
Item 20. Eating/drinking inappropriate substances
Item 31. Hurt self or other (cigarette, hot water, etc.)
Item 42. Handling things inappropriately
Item 23. Hiding things
Item 24. Hoarding things
Item 25. Tearing things or destroying property
Item 26. Performing repetitious mannerisms
Item 27. Making verbal sexual advances
Item 28. Making physical sexual advances
Item 29. General restlessness
References
Cohen-Mansfield, J., Marx, M. S., & Rosenthal, A. S. (1989). A description of agitation in a nursing home. Journal of Gerontology: Medical Sciences, 44(3), M77-M84.
Werner, P., Cohen-Mansfield, J., Koroknay, V., & Braun J. (1994). The impact of a restraintreduction
program on nursing home residents. Geriatric Nursing, 15(3), 142-146.
Cohen-Mansfield, J., Werner, P., Watson, V., & Pasis, S. (1995). Agitation in participants of adult
day care centers: The experiences of relatives and staff members. International
Psychogeriatrics, 7(3), 447-458.
Avril 2010
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