Access Type

Open Access Dissertation

Date of Award

January 2020

Degree Type


Degree Name




First Advisor

Debra L. Schutte


Background: Worldwide population trends are shifting with the population of Elders expected to dramatically increase in absolute and relative numbers in coming years. Alzheimer Disease (AD) is a common and costly disease of aging with agitation being the most poorly managed and detrimental behavioral symptom of the condition. The Nursing Theory of Unpleasant Symptoms provides a conceptual basis for understanding agitated behavioral symptoms associated with AD in the context of its antecedent causes and outcomes of the symptoms.

Purpose: The purpose of this dissertation was to model the predictors and outcomes of agitated behavioral symptoms in persons with AD. The specific aims were: (1) Describe the phenomenon of agitated behavioral symptoms in persons with AD within the Theory of Unpleasant Symptoms; (2) Determine the effect of situational, psychological, and physiological factors on agitation in persons with AD; (3) Determine the effect of situational, psychological, and physical antecedent factors and agitation on performance outcomes.

Methods: A descriptive, correlational, cross-sectional, secondary analysis research design will be employed. The original data were collected in communities and in Nursing Homes settings in the Midwestern US. A convenience sampling of facilities yielded 120 participants.

Results: Exploratory factor analysis identified three antecedent factors to agitated behavioral symptoms: Situation-Caregiver, Psychological, and Physical-Cognitive. The path analysis model closely represented all variables and relationships predicted in the TOUS (χ2 = 1.049, df = 2, p = .592). Significant relationships between situation and agitation (B = 0.51, p < .001), psychological symptoms and agitation (B = 0.446, p < .001), and physical health on agitated behavioral symptoms (B = 0.58, p = .001) were found, and explained 63% of the variance in agitation. The model found no support for the effects of any measured factors on performance outcomes, except the effects of the Physical: Cognitive factor (B = 0.86, p < .001) which explained 66% of the variance in functional performance.

Implications: The TOUS provides a good model to identify causes of agitated behaviors in AD. This study emphasizes the need for greater support of caregivers of persons with AD because caregiver burden is an important modifiable antecedent to agitated behavioral symptoms. Future research should investigate interventions to reduce professional and informal caregiver burnout and study the effects of reduced caregiver burnout on improvements in agitated behavioral symptoms in persons with AD. Future research should also evaluate quality of life outcomes to better determine if the relationships between symptoms and performance outcomes predicted in the TOUS remain valid in persons with AD.

Included in

Nursing Commons