Pittsburgh Agitation Scale (PAS)
4-item survey to monitor the severity of agitation associated with dementia based on direct observations of the patient.
Provided by
EVAL FoundationInstructions
- Circle only the highest intensity score for each behavior group that you observed during this rating period.
- Use the anchor points as a guide to choose a suitable level of severity.
- Not all anchor points need be present.
- Choose the more severe level when in doubt.
Observation Period
According to Rosen et al (1994), "There are many rating instruments designed to assess symptoms of agitation in patients with dementia. Most scales require that raters assess multiple specific behaviors over several days, limiting the use of such scales to clinical staff who have direct contact with patients but do not have the time to complete a comprehensive assessment following each period of observation. Also, scales that assess behavior over several days must rely on "secondhand" information describing behaviors not directly observed by the rater. The Pittsburgh Agitation Scale (PAS) is an easy-to-use instrument, based on direct observations of the patient, that was developed to monitor the severity of agitation associated with dementia. Interrater reliability and measures of validity have been established with clinical staff on a busy psychogeriatric inpatient unit and with research personnel in a nursing home setting."
Scoring
The Pittsburgh Agitation Scale (PAS) is scored based on the intensity of observed behaviors across four behavior groups. Each of the four groups is rated on a scale from 0 to 4, based on the intensity and disruptiveness of the behaviors observed during the rating period:
- Aberrant Vocalization
- Motor Agitation
- Aggressiveness
- Resisting Care
The rating for each group is the highest intensity score observed during that period, using anchor points to determine the level of severity (0 being "Not present" and 4 being the most severe).
Note: According to some sources, the scores for these four items are not totaled into a single overall score, although other contexts suggest a total score is used for tracking improvement. The primary focus is on the individual item scores and the overall pattern. The maximum possible score if they were totaled would be 4 x 4 = 16.
All questions & possible results
Observation Period
Start Date & Time
A date and time.
End Date & Time
A date and time.
Hours of sleep this rating period
A number between 0 and 10000, in hours.
Aberrant VocalizationTitle not visible
Aberrant Vocalization
- Examples: repetitive requests or complaints, nonverbal vocalizations, e.g., moaning, screaming
Select one option:
- Not present
- Low volume, not disruptive in milieu, including crying
- Louder than conversational, mildly disruptive, redirectable
- Loud, disruptive, difficult to redirect
- Extremely loud screaming or yelling, highly disruptive, unable to redirect
Motor AgitationTitle not visible
Motor Agitation
- Examples: pacing, wandering, moving in chair, picking at objects, disrobing, banging on chair, taking others’ possessions.
- Rate “intrusiveness” by normal social standards, not by effect on other patients in milieu.
- If “intrusive” or “disruptive” due to noise, rate under “Vocalization.”
Select one option:
- Not present
- Pacing or moving about in chair at normal rate (appears to be seeking comfort, looking for spouse, purposeless movements)
- Increased rate of movements, mildly intrusive, easily redirectable
- Rapid movements, moderately intrusive or disruptive, difficult to redirect
- Intense movements extremely intrusive or disruptive, not redirectable verbally
AggressivenessTitle not visible
Aggressiveness
- Score ‘0’ if aggressive only when resisting care
Select one option:
- Not present
- Verbal threats
- Threatening gestures; no attempt to strike
- Physical toward property
- Physical toward self or others
Resisting CareTitle not visible
Resisting Care
Select one option:
- Not present
- Procrastination or avoidance
- Verbal gesture of refusal
- Pushing away to avoid task
- Striking out at a caregiver
When is care resisted?
Select all that apply.
Select all that apply:
- Washing
- Dressing
- Eating
- Meds
- Other care
Specify "Other care" resisted
A free-text response.
InterventionsTitle not visible
Were any of the following used during this rating period because of behavior problems?
Select interventions used.
Select all that apply:
- Seclusion
- PRN Meds
- Restraint
- Other interventions
- None
Specify "PRN Meds"
A free-text response.
Specify "Other interventions"
A free-text response.
Possible results
Total PAS Score
- According to some sources, the scores for these four items are not totaled into a single overall score.
- Although other contexts suggest a total score is used for tracking improvement.
- The primary focus is on the individual item scores and the overall pattern.
Citation
Rosen J, Burgio L, Kollar M, Cain M, Allison M, Fogleman M, Michael M, Zubenko GS. A user-friendly instrument for rating agitation in dementia patients. Am J Geriatr Psychiatry. 1994 Winter;2(1):52-9. PMID: 21629007.
Literature
- A user-friendly instrument for rating agitation in dementia patients. Am J Geriatr Psychiatry. 1994 Winter;2(1):52-9. PMID: 21629007. — Rosen J, Burgio L, Kollar M, Cain M, Allison M, Fogleman M, Michael M, Zubenko GS
