Date of Award

Spring 5-2013

Degree Type

Honors College Thesis



First Advisor

Elizabeth Harrison

Advisor Department



Alzheimer’s disease (AD) is the most common form of dementia, representing 60 percent of all cases, and is described as a chronic, progressive, degenerative cognitive disorder. With loss of independence due to cognitive impairment, AD patients become more confused and anxious, which leads to a higher incidence of aggression towards nursing staff. It is paramount that the nursing community seeks new evidence-based healthcare innovations to reduce aggression and to protect caregivers. The aim of this study was to determine the effectiveness of individualizing interventions informed by the Hierarchic Dementia Scale (HDS) to reduce aggressive behaviors in people with Alzheimer’s disease.

This thesis project is a case study that was conducted in a nursing home in South Mississippi in collaboration with LPNs & CNAs who worked on the Alzheimer’s unit. The participant was diagnosed with AD and displayed aggressive behavior. Aggressive episodes were recorded on observation sheets developed by the Principal Investigator (PI). Once the baseline data were established, the PI administered the HDS tool to the participant. Using scores from the HDS, and the accompanying implementation manual, the PI developed interventions


tailored to the participant. Observations were repeated with the interventions in place.

Baseline trends showed that aggressive episodes only occurred in the bathroom and shower room; therefore, interventions were heavily implemented in these areas. Results revealed that aggressive behavior was reduced by 28.6 percent. Aggressive episodes increased in number, but decreased in intensity. Staff also claimed that the participant was ‘much calmer’ and ‘the interventions made a huge improvement on her behavior.’

The small sample size and time constraints were limitations to this study. Longitudinal studies with larger samples may improve our ability to generalize the findings and to further validate the HDS tool’s success in developing interventions to manage aggression in AD patients. The results of this study, however, suggest that the HDS appears to be helpful in developing interventions that reduce aggressive behaviors in AD patients, thereby contributing to safer environments for both clients and caregivers.