Background: Agitation is common in nursing home residents with dementia and is associated with high burden for the residents, their relatives and their caregivers. These consequences increase if symptoms of agitation are severe. Although it is assumed that agitation and quality of life are related, knowledge about severe agitation and its relation to single dimensions of quality of life is limited.

Objective: To examine the relationship between the severity of agitation and social isolation as a dimension of quality of life in people with dementia living in German nursing homes.

Methods: An explorative secondary data analysis of data from an observational study with 1947 residents from 66 German nursing homes was conducted. Agitation was defined as a construct of the items agitation/aggression, irritability and disinhibition of the Neuropsychiatric-Inventory Questionnaire (NPI-Q). Social isolation, as one of the dimensions of quality of life, was measured with a subscale of the short version of the QUALIDEM-instrument. First, a matching procedure was carried out to choose two groups with similar baseline characteristics, one with residents with severe agitation and one with residents with mild or no agitation. Second, a linear regression model and Mann-Whitney U tests were calculated to determine differences in the dimension of social isolation and its single items.

Results: A significant relationship was found between the severity of agitation and the dimension of social isolation (-1.92 (CI 95%: -2.41, -1.43)). Besides the finding in the total score of the dimension of social isolation, significant differences were found in all three items defining this dimension (calls out; openly rejects contact with others; is rejected by other residents). In particular, the item ‘is rejected by other residents’ was often rated as applicable for people with dementia with severe agitation.

Conclusion: Severe agitation is associated with lower values of quality of life in the dimension of social isolation and its defining items. In daily practice and in research, more attention should be paid to severe agitation. Furthermore, interventions that aim to influence both the severity of agitation and the quality of life should have a stronger focus on causes of social isolation.