Despite advances in dementia care some people who live in nursing homes are still suffering from agitation. These individuals may be exposed to non therapeutic levels of stimulation particularly sound levels. There is insufficient research that examines the relationship between the environmental stressors of sound and space to agitation in people suffering from dementia. The purposes of the research were to (a) describe the sound levels and space experienced in nursing home settings and (b) explore the extent that the factors of sound and space may contribute to agitation in people with dementia who live there. The factors of sound and space were chosen based on the Environmental Press and Progressively Lowered Stress Threshold models which suggest that physical environment may impact the behavior in people with cognitive impairment.

A convenience sampling method yielded 53 participants from 4 Midwestern nursing homes. Participants age ranged from 61 to 103 years with moderate (n=16) to severe (n=37) dementia. Data were collected using a demographic eligibility form, the Mini Mental Status Examination, Minimum Data Set, Discomfort Scale for Dementia of Alzheimer's Type, Wisconsin Agitation Inventory, Observation Log, and Sound Decibel Meter. Sound levels, space where the sound observations occurred, and participant levels of agitation were observed concurrently.

Data analyses included Pearson product moment correlations and multiple regression models. Sound was a significant predictor of mid-day agitation, 19% of the variance in mid-day agitation was uniquely accounted for by mid-day sound levels (F(5, 47) = 4.312, p ≤ .005 and adjusted R² .242). The accumulation of sound predicted agitated behavior and explained 16% of the variance (F(5, 47) = 4.520, p ≤ .001 and adjusted R² .253).

The findings of this study suggest that sound contributes to agitation in people suffering from dementia who live in nursing homes. These findings raise the possibility that the expression of agitation may be a method of communication that the environment is too loud. With practice changes, the comfort and well-being of people with dementia living in a nursing home facility can be improved.