The Minimum Data Set Agitated and Reactive Behavior Scale: Measuring Behaviors in Nursing Home Residents With Dementia

J Am Med Dir Assoc. 2019 Dec;20(12):1548-1552. doi: 10.1016/j.jamda.2019.08.030. Epub 2019 Oct 31.


Objectives: Interventions aimed at managing agitated and aggressive behaviors in dementia without the use of antipsychotics are currently being tested in nursing homes (NHs). Researchers and clinicians require a measure that can capture the severity of residents' behaviors. We test the internal consistency and construct validity of the Agitated and Reactive Behavior Scale (ARBS), a measure created using data from mandatory NH assessments.

Design: Cross-sectional.

Setting and participants: The 2016 national sample of 15,326 Centers for Medicare and Medicaid Services-certified NHs. The analytic sample included 489,854 new admissions and 765,367 long-stay residents (at least 90 days in NH). All participants have a dementia diagnosis.

Methods: Minimum Data Set (MDS), version 3.0. The ARBS is a composite measure of (1) physical behavioral symptoms directed at other people; (2) verbal behavioral symptoms directed at other people; (3) other behavioral symptoms not directed at other people; and (4) rejection of care. Variables used to establish construct validity included degree of cognitive impairment, use of medications for managing agitation and aggression, and co-occurring conditions associated with agitated and aggressive behaviors (eg, schizophrenia, depression, or delirium).

Results: This report has 3 important findings: (1) the ARBS score has borderline-adequate internal consistency (α = .64-.71) in the national population NH residents with dementia; (2) only 18% of new admissions and 21% of long-stay residents with dementia evidence any agitated or aggressive behaviors in the last week, as rated in the MDS assessment; and (3) the ARBS demonstrates good construct validity; it increases with cognitive impairment, treatment with relevant medications, and co-occurring psychiatric conditions and symptoms.

Discussion: Nationally available MDS data may significantly underestimate the prevalence of agitated and aggressive behaviors among NH residents with dementia.

Conclusions and implications: Researchers conducting pragmatic trials of non-pharmaceutical interventions to manage behaviors in NH residents with dementia should consider the likely underdetection of these behaviors in the available MDS data.

Keywords: Dementia; behaviors; measurement; nursing home.

Publication types

  • Research Support, N.I.H., Extramural
  • Validation Study

MeSH terms

  • Aged, 80 and over
  • Aggression*
  • Anti-Anxiety Agents / therapeutic use
  • Antidepressive Agents / therapeutic use
  • Antipsychotic Agents / therapeutic use
  • Cross-Sectional Studies
  • Dementia / drug therapy
  • Dementia / psychology*
  • Drug Utilization / statistics & numerical data
  • Female
  • Geriatric Assessment*
  • Humans
  • Male
  • Mental Disorders / epidemiology
  • Nursing Homes
  • Psychomotor Agitation*
  • Reproducibility of Results
  • Severity of Illness Index
  • United States / epidemiology


  • Anti-Anxiety Agents
  • Antidepressive Agents
  • Antipsychotic Agents