Although there are many measures of aggression, only a few have been specifically designed for use with older adults and even fewer have been psychometrically evaluated in a sample from late-life. Given the considerable clinical and research interest in aggression, it is important that such measures be well-designed, standardized and rigorously evaluated for psychometric properties in a late-life sample prior to being used for clinical or research purposes.
Aggressiveness is a highly complex concept that can be difficult to measure accurately, particularly in the context of people with cognitive impairment or severe dementia. The current literature on aggressiveness scale in this population consists of a mix of observational and self-report measures. In general, such measures are characterized by a high rate of false positives, with many people being identified as aggressive who do not meet diagnostic criteria for the condition. A number of potential strategies to address these problems have been proposed including the use of new measures, redefining the nature of aggression in the context of dementia or applying a more sophisticated approach to the measurement of aggressiveness in this population.
The Behavioral Pathology in Alzheimer’s Disease Rating Scale (BEHAVE-AD) is one of the most widely used observations of behavioral disturbances in people with Alzheimer’s and includes items that assess physical aggression. The BEHAVE-AD also contains a subscale assessing uncooperative or aggressive behavior, which encompasses resistance to care, verbal aggression and physical assault. The BEHAVE-AD has been shown to be reliable and valid in a variety of settings.
The Pittsburgh Agitation Scale (PAS) is a four-item observational measure of agitation that consists of items assessing vocalization, motor agitation, aggressiveness and resistance to care. Observers rate each of the four dimensions on a scale from 0 to 4 with varying anchor points and then a total score is generated. The PAS has been shown to be reliable and valid in various settings, including an inpatient geropsychiatry unit and a nursing home. The PAS has also been shown to correlate significantly with ratings made by observers using real-time microcomputer monitoring for agitation.
A number of measures have been developed to assess aggression and anger in competitive sport. However, these measures have been criticised for not adequately considering the nature of sport and the fact that some acts of aggression are an integral part of a specific sport. A questionnaire was developed to assess trait anger and aggressiveness in athletes, a measure called the Competitive Aggressiveness and Anger Scale (CAAS). The CAAS has been found to have good test-retest reliability, construct validity and discriminant validity. This scale is a valuable tool for researchers in the field of competitive sports aggression and should be used with caution when studying aggressiveness and anger in the sport context.