French version of the Rating Scale for Aggressive Behaviour in the Elderly (F-RAGE): Psychometric properties and diagnostic accuracy

Adama, Barry; Benjamin, Calvet; Jean-Pierre, Clément; Michel, Druet-Cabanac; Annie, Prado-Jean

doi:10.1590/S1980-57642013DN70300008

ABSTRACT

Aggressive behaviour is the most disturbing and distressing behaviour displayed by elderly people. The prevalence of aggressive behaviour is around 50% among psychogeriatric patients.

Objective:

This study sought to analyze the psychometric properties and diagnostic accuracy of the French version of the Rating Scale for Aggressive Behaviour in the Elderly (F-RAGE).

Methods:

The F-RAGE was administered to 79 patients hospitalized in a geriatric psychiatry department. A psychiatrist, who was blind to the subjects' RAGE scores, performed the diagnosis for aggressivity based on global clinical impression. The F-RAGE and MMSE were applied by a trained researcher blind to subjects' clinical diagnoses while the Cohen-Mansfield Agitation Inventory and Neuropsychiatric Inventory were administered by medical and nursing staff. Internal consistency, reliability, cut-off points, sensitivity and specificity for F-RAGE were estimated.

Results:

F-RAGE showed satisfactory validity and reliability measurements. Regarding reliability, Cronbach's a coefficient was satisfactory with a value of 0.758. For diagnostic accuracy, a cut-off point of 8 points (sensitivity=74.19%; specificity=97.98%) and area under curve of 0.960 were estimated to distinguish between aggressive patients and control subjects.

Discussion:

F-RAGE showed acceptable psychometric properties, supported by evidence of validity and reliability for its use in the diagnosis of aggressive behaviour in elderly.

Key words:
aggressive behaviour; psychogeriatric; RAGE; CMAI; NPI.

RESUMO

O comportamento agressivo é o comportamento mais perturbador e angustiante que possa ser apresentado pelos idosos. A prevalência de comportamento agressivo é cerca de 50% entre os pacientes psicogeriátricos.

Objetivo:

Analisar as propriedades psicométricas e acurácia diagnóstica da versão francesa da Escala de Avaliação do Comportamento Agressivo em Idosos (F-RAGE).

Métodos:

A F-RAGE foi administrada a 79 pacientes internados no departamento de psiquiatria geriátrica. Um psiquiatra que era cego às pontuações F-RAGE dos sujeitos realizou o diagnóstico de DSM-IV com base na impressão clínica global. O F-RAGE e MMSE foram realizados por um pesquisador treinado cego ao diagnóstico clínico dos sujeitos e o Inventário de agitação de Cohen-Mansfield e o Inventário Neuropsiquiátrico pela equipe médica e de enfermagem. Consistência interna, pontos de corte, sensibilidade e especificidade para F-RAGE foram estimados.

Resultados:

F-RAGE mostrou validade satisfatória e medidas de confiabilidade. Em relação à confiabilidade, coeficiente a de Cronbach foi satisfatória com um valor de 0,758. Para maior precisão de diagnóstico, um ponto de corte de 8 pontos (sensibilidade=74,2%, especificidade=98,0%) e área sob a curva de 0,960 foram estimados para distinguir entre os pacientes agressivos e controles.

Discussão:

F-RAGE mostrou propriedades psicométricas aceitáveis, apoiados por evidências de validade e confiabilidade para sua utilização no diagnóstico do comportamento agressivo em idosos.

Palavras-chave:
comportamento agressivo; psicogeriátricos; RAGE; CMAI; NPI.

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REFERENCES

Patel V, Hope RA. A rating scale for aggressive behaviour in the elderly-the RAGE. Psychol Med 1992;22:211-221.
Voyer P, Verreault R, Azizah GM, Desrosiers J, Champoux N, Bédard A. Prevalence of physical and verbal aggressive behaviours and associated factors among older adults in long-term care facilities. BMC Geriatr 2005;5:13.
Berg G, Edwards DF, Danzinger WL, Berg L. Longitudinal change in three brief assessments of SDAT. J Am Geriatr Soc 1987;35:205-212.
Talerico KA, Evans LK, Strumpf NE. Mental health correlates of aggression in nursing home residents with dementia. Gerontologist 2002; 42:169-177.
Patel V, Hope T. Aggressive behavior in elderly people with dementia: A review. Int J Geriatr Psychiatry 1993;8:457-472.
Lam LCW, Chui HF, NG J. Aggressive behaviour in the Chinese elderly- validation of the Chinese version of the rating scale for aggressive behaviour in the elderly (RAGE) in hospital and nursing home settings. Int J Geriatr Psychiatry1997;12:678-681.
Rabins PV, Mace NL, Lucas MJ. The impact of dementia on the family. JAMA 1982;248:333-335.
Zimmer JG, Watson N, Treat A. Behavioral problems among patients in skilled nursing facilities. Am J Public Health 1984;74:1118-1121.
Ryden MB. Aggressive behavior in persons with dementia who live in the community. Alzheimer Dis Assoc Disord 1988;2:342-355.
Cohen-Mansfield J, Billig N. Agitated behaviors in the elderly. J Am Geriatr Soc1986;34:711-721.
Cohen-Mansfield J, Marx MS, Rosenthal AS. A description of agitation in a nursing home. J Gerontol Med Sci 1989;44:M77-M84.
Micas M, Ousset PJ, Vellas B. Évaluation des troubles du comportement. Présentation de léchelle de Cohen-Mansfield. La Revue Française de Psychiatrie et de Psychologie Médicale. 1997;151-154.
Folstein MF, Folstein SE, McHugh PR."Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
Cumming JL, Mega MS, Gray K, Rosemberg -Thompson S, Gornbein T. The Neuropsychiatric Inventory: comprehensive assessement of psychopathology in dementia. Neurology 1994;44:2308-2314.
Salzman C, Jeste DV, Meyer RE, et al. Elderly patients with dementia-related symptoms of severe agitation and aggression: consensus statement on treatment options, clinical trials methodology, and policy. J Clin Psychiatry 2008;69:889-898.
Zuidema SU, de Jonghe JF, Verhey FR, Koopmans RT. Predictors of neuropsychiatric symptoms in nursing home patients: influence of gender and dementia severity. Int J Geriatr Psychiatry2009;24:1079-1086.
Margari F, Sicolo M, Spinelli L, et al. Aggressive behavior, cognitive impairment, and depressive symptoms in elderly subjects. Neuropsychiatr Dis Treat 2012;8:347-353.
Brodaty H, Low LF. Aggression in the elderly. J Clin Psychiatry2003; 64 Suppl 4:36-43.
Zeller A, Hahn S, Needham I, Kok G, Dassen T, Halfens RJ. Aggressive behavior of nursing home residents toward caregivers: a systematic literature review. Geriatr Nurs 2009;30:174-187.
Cornaggia CM, Beghi M, Pavone F, Barale F. Aggression in psychiatry wards: a systematic review. Psychiatry Res 2011;189:10-20.
Brodaty H, Draper B, Saab D, et al. Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors. Int J Geriatr Psychiatry2001;16:504-512.
Teresi J, Morris J, Mattis S, Reisberg B. Cognitive impairment among SCU and non-SCU residents in the United States: Estimates from the National Institutes on Aging collaborative studies of dementia special care units for Alzheimer's disease. Res Pract Alzheimers Dis 2001; 4:117-138.
Rosen T, Pillemer K, Lachs M. Resident-to-Resident Aggression in Long-Term Care Facilities: An Understudied Problem. Aggress Violent Behav 2008;13:77-87.
Gothelf D, Apter A, van Praag HM. Measurement of aggression in psychiatric patients. Psychiatry Res1997;71:83-95.
Suris A, Lind L, Emmett G, Borman PD, Kashner M, Barratt ES. Measures of aggressive behavior: overview of clinical and research instruments. Aggress Violent Behav2004;9:165-227.
Nunnally JC, Bernstein I. Psychometric theory, 2nd edition. New York: McGraw-Hill, 1978:736p.
Burton LC, Rovner BW, German PS, Brant LJ, Clark RD. Neuroleptic use and behavioral disturbance in nursing homes: a 1-year study. Int Psychogeriatr 1995;7:535-545.
Devanand DP, Marder K, Michaels KS, et al. A randomized, placebo-controlled dose-comparison trial of haloperidol for psychosis and disruptive behaviors in Alzheimer's disease. Am J Psychiatry 1998;155: 1512-1520.
Shah AK. Violence and psychogeriatric inpatients with dementia. Int J Psychogeriatr 1992;7:39-44.
Brodaty H, Ames D, Snowdon J, et al. A randomized placebo-controlled trial of risperidone for the treatment of aggression, agitation, and psychosis of dementia. J Clin Psychiatry2003;64:134-143.
Haute Autorité de la Santé. Maladie d'Alzheimer et maladies apparentées : prise en charge des troubles du comportement perturbateurs 2009. http://www.has-sante.fr.
» http://www.has-sante.fr.
Pulsford D, Duxbury J. Aggressive behaviour by people with dementia in residential care settings: a review. J Psychiatr Ment Health Nurs. 2006;13:611-618.
Draper B, Snowdon J, Meares S, et al. Case-controlled study of nursing home residents referred for treatment of vocally disruptive behavior.. Int Psychogeriatr 2000;12:333-344.
Sourial R, McCusker J, Cole M, Abrahamowicz M. Agitation in demented patients in an acute care hospital: prevalence, disruptiveness, and staff burden. Int Psychogeriatr2001;13:183-197.
Meddaugh DI. Reactance. Understanding aggressive behavior in long-term care. J Psychosoc Nurs Ment Health Serv 1990;28:28-33.
Tinetti ME, Liu WL, Marottoli RA, Ginter SF. Mechanical restraint use among residents of skilled nursing facilities. Prevalence, patterns, and predictors. JAMA1991;265:468-471.
Fogarty JS. Reactance theory and patient noncompliance. Soc Sci Med 1997;45:1277-1288.
Ryden MB, Feldt KS, Oh HL, et al. Relationships between aggressive behavior in cognitively impaired nursing home residents and use of restraints, psychoactive drugs, and secured units. Arch Psychiatr Nurs 1999;13:170-178.
Laurin D, Voyer P, Verreault R, Durand PJ. Physical restraint use among nursing home residents: A comparison of two data collection methods. BMC Nurs 2004;3:5.
Gates D, Fitzwater E, Mayer U. Violence against caregivers in nursing homes: expected, tolerated and accepted. J Gerontol Nurs 1999;25: 12-21.
Rodney V. Nurse stress associated with aggression in people with dementia: its relationship to hardiness, cognitive appraisal and coping. J Adv Nurs 2000;31:172-80.
Evers W, Tomic W, Brouwers A. Aggressive behaviour and burnout among staff of homes for the elderly. Int J Ment Health Nurs 2002;11: 2-9.
Astrom S, Karlsson S, Bucht Get, al. Staff's experience of the management of violent inci dents in elderly care. Scand J Caring Sci 2004;18: 410-416.
Jansen GJ, Dassen TW, Groot Jebbink G. Staff attitudes towards aggression in health care: a review of the literature. J Psychiatr Ment Health Nurs 2005;12:3-13.

Publication Dates

Publication in this collection
Jul-Sep 2013

History

Received
05 July 2013
Accepted
06 Aug 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Patel V, Hope RA. A rating scale for aggressive behaviour in the elderly-the RAGE. Psychol Med 1992;22:211-221.

[2] Voyer P, Verreault R, Azizah GM, Desrosiers J, Champoux N, Bédard A. Prevalence of physical and verbal aggressive behaviours and associated factors among older adults in long-term care facilities. BMC Geriatr 2005;5:13.

[3] Berg G, Edwards DF, Danzinger WL, Berg L. Longitudinal change in three brief assessments of SDAT. J Am Geriatr Soc 1987;35:205-212.

[4] Talerico KA, Evans LK, Strumpf NE. Mental health correlates of aggression in nursing home residents with dementia. Gerontologist 2002; 42:169-177.

[5] Patel V, Hope T. Aggressive behavior in elderly people with dementia: A review. Int J Geriatr Psychiatry 1993;8:457-472.

[6] Lam LCW, Chui HF, NG J. Aggressive behaviour in the Chinese elderly- validation of the Chinese version of the rating scale for aggressive behaviour in the elderly (RAGE) in hospital and nursing home settings. Int J Geriatr Psychiatry1997;12:678-681.

[7] Rabins PV, Mace NL, Lucas MJ. The impact of dementia on the family. JAMA 1982;248:333-335.

[8] Zimmer JG, Watson N, Treat A. Behavioral problems among patients in skilled nursing facilities. Am J Public Health 1984;74:1118-1121.

[9] Ryden MB. Aggressive behavior in persons with dementia who live in the community. Alzheimer Dis Assoc Disord 1988;2:342-355.

[10] Cohen-Mansfield J, Billig N. Agitated behaviors in the elderly. J Am Geriatr Soc1986;34:711-721.

[11] Cohen-Mansfield J, Marx MS, Rosenthal AS. A description of agitation in a nursing home. J Gerontol Med Sci 1989;44:M77-M84.

[12] Micas M, Ousset PJ, Vellas B. Évaluation des troubles du comportement. Présentation de léchelle de Cohen-Mansfield. La Revue Française de Psychiatrie et de Psychologie Médicale. 1997;151-154.

[13] Folstein MF, Folstein SE, McHugh PR."Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.

[14] Cumming JL, Mega MS, Gray K, Rosemberg -Thompson S, Gornbein T. The Neuropsychiatric Inventory: comprehensive assessement of psychopathology in dementia. Neurology 1994;44:2308-2314.

[15] Salzman C, Jeste DV, Meyer RE, et al. Elderly patients with dementia-related symptoms of severe agitation and aggression: consensus statement on treatment options, clinical trials methodology, and policy. J Clin Psychiatry 2008;69:889-898.

[16] Zuidema SU, de Jonghe JF, Verhey FR, Koopmans RT. Predictors of neuropsychiatric symptoms in nursing home patients: influence of gender and dementia severity. Int J Geriatr Psychiatry2009;24:1079-1086.

[17] Margari F, Sicolo M, Spinelli L, et al. Aggressive behavior, cognitive impairment, and depressive symptoms in elderly subjects. Neuropsychiatr Dis Treat 2012;8:347-353.

[18] Brodaty H, Low LF. Aggression in the elderly. J Clin Psychiatry2003; 64 Suppl 4:36-43.

[19] Zeller A, Hahn S, Needham I, Kok G, Dassen T, Halfens RJ. Aggressive behavior of nursing home residents toward caregivers: a systematic literature review. Geriatr Nurs 2009;30:174-187.

[20] Cornaggia CM, Beghi M, Pavone F, Barale F. Aggression in psychiatry wards: a systematic review. Psychiatry Res 2011;189:10-20.

[21] Brodaty H, Draper B, Saab D, et al. Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors. Int J Geriatr Psychiatry2001;16:504-512.

[22] Teresi J, Morris J, Mattis S, Reisberg B. Cognitive impairment among SCU and non-SCU residents in the United States: Estimates from the National Institutes on Aging collaborative studies of dementia special care units for Alzheimer's disease. Res Pract Alzheimers Dis 2001; 4:117-138.

[23] Rosen T, Pillemer K, Lachs M. Resident-to-Resident Aggression in Long-Term Care Facilities: An Understudied Problem. Aggress Violent Behav 2008;13:77-87.

[24] Gothelf D, Apter A, van Praag HM. Measurement of aggression in psychiatric patients. Psychiatry Res1997;71:83-95.

[25] Suris A, Lind L, Emmett G, Borman PD, Kashner M, Barratt ES. Measures of aggressive behavior: overview of clinical and research instruments. Aggress Violent Behav2004;9:165-227.

[26] Nunnally JC, Bernstein I. Psychometric theory, 2nd edition. New York: McGraw-Hill, 1978:736p.

[27] Burton LC, Rovner BW, German PS, Brant LJ, Clark RD. Neuroleptic use and behavioral disturbance in nursing homes: a 1-year study. Int Psychogeriatr 1995;7:535-545.

[28] Devanand DP, Marder K, Michaels KS, et al. A randomized, placebo-controlled dose-comparison trial of haloperidol for psychosis and disruptive behaviors in Alzheimer's disease. Am J Psychiatry 1998;155: 1512-1520.

[29] Shah AK. Violence and psychogeriatric inpatients with dementia. Int J Psychogeriatr 1992;7:39-44.

[30] Brodaty H, Ames D, Snowdon J, et al. A randomized placebo-controlled trial of risperidone for the treatment of aggression, agitation, and psychosis of dementia. J Clin Psychiatry2003;64:134-143.

[31] Haute Autorité de la Santé. Maladie d'Alzheimer et maladies apparentées : prise en charge des troubles du comportement perturbateurs 2009. http://www.has-sante.fr.
» http://www.has-sante.fr.

[32] Pulsford D, Duxbury J. Aggressive behaviour by people with dementia in residential care settings: a review. J Psychiatr Ment Health Nurs. 2006;13:611-618.

[33] Draper B, Snowdon J, Meares S, et al. Case-controlled study of nursing home residents referred for treatment of vocally disruptive behavior.. Int Psychogeriatr 2000;12:333-344.

[34] Sourial R, McCusker J, Cole M, Abrahamowicz M. Agitation in demented patients in an acute care hospital: prevalence, disruptiveness, and staff burden. Int Psychogeriatr2001;13:183-197.

[35] Meddaugh DI. Reactance. Understanding aggressive behavior in long-term care. J Psychosoc Nurs Ment Health Serv 1990;28:28-33.

[36] Tinetti ME, Liu WL, Marottoli RA, Ginter SF. Mechanical restraint use among residents of skilled nursing facilities. Prevalence, patterns, and predictors. JAMA1991;265:468-471.

[37] Fogarty JS. Reactance theory and patient noncompliance. Soc Sci Med 1997;45:1277-1288.

[38] Ryden MB, Feldt KS, Oh HL, et al. Relationships between aggressive behavior in cognitively impaired nursing home residents and use of restraints, psychoactive drugs, and secured units. Arch Psychiatr Nurs 1999;13:170-178.

[39] Laurin D, Voyer P, Verreault R, Durand PJ. Physical restraint use among nursing home residents: A comparison of two data collection methods. BMC Nurs 2004;3:5.

[40] Gates D, Fitzwater E, Mayer U. Violence against caregivers in nursing homes: expected, tolerated and accepted. J Gerontol Nurs 1999;25: 12-21.

[41] Rodney V. Nurse stress associated with aggression in people with dementia: its relationship to hardiness, cognitive appraisal and coping. J Adv Nurs 2000;31:172-80.

[42] Evers W, Tomic W, Brouwers A. Aggressive behaviour and burnout among staff of homes for the elderly. Int J Ment Health Nurs 2002;11: 2-9.

[43] Astrom S, Karlsson S, Bucht Get, al. Staff's experience of the management of violent inci dents in elderly care. Scand J Caring Sci 2004;18: 410-416.

[44] Jansen GJ, Dassen TW, Groot Jebbink G. Staff attitudes towards aggression in health care: a review of the literature. J Psychiatr Ment Health Nurs 2005;12:3-13.

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