The aim of this study was to identify factors associated with vocally disruptive behavior (VDB) in nursing home patients referred to aged care services for treatment, using a case-control methodology. Characteristics of the VDB, reasons for referral, perceived causal factors, and psychotropic use were noted. Twenty-five subjects and controls were examined with the Screaming Behavior Mapping Instrument, the Cornell Scale for Depression in Dementia, the Dementia Behavior Disturbance Scale, and measures of cognition, functional capacity, social activities, and emotional reactions of nursing staff. VDB was associated with other disturbed behaviors, depression, anxiety, severe dementia, functional impairment, communication difficulties, use of psychotropic medication, social isolation, and emotional distress in the nursing staff. Reasons for referral may relate more to the stress experienced by nursing home staff in managing VDB than to specific attributes of the VDB itself.

Vocally Disruptive Behaviour (VDB) is a term that includes screaming, abusive language, moaning, perseveration, and repetitive and inappropriate requests. It is one of the most challenging behaviours for nursing home staff, caregivers for people with dementia, and other nursing home residents. As with other behavioural disturbances, multiple causal factors have been identified in the literature and individual cases may have a number of interacting factors. There is a lack of consensus about how to treat VDB. Systematic treatment studies are few and there is a lack of empirical data supporting the effectiveness of specific interventions commonly used in clinical practice. This hinders clinicians and may result in the use of inappropriate treatments. Our aim was to systematically review the literature in order to develop a practice guideline for the assessment and management of VDB. The review will examine the typology, risk factors and management of VDB.

While there is evidence to suggest that in long term residential care settings the provision of more choices and better designed environments have a positive effect on agitation and disturbed behaviors, there are no controlled studies on the effect of imposed confinement in these settings or in acute units.The effect of mandatory confinement indoors on the incidence of verbal and physical aggression and psychotropic medication use among patients with dementia and associated psychiatric and behavioral disturbance was studied. The setting was an acute psychogeriatric admission unit accommodated in a colonial building originally built as a military barracks. A convenience sample was studied to assess changes in levels of aggression and nurse-initiated psychotropic medication use during and after a 32-day period of indoor confinement. Correlations with gender, diagnosis, pre-admission disturbed behavior and ultimate discharge outcome were examined.Release from mandatory confinement indoors was correlated with decreases in both verbal and physical aggression as well as medication use. Correlations could be identified between decreases in aggression and male gender, pre-admission aggressive behavior and discharge outcome. Decreased medication use was correlated with discharge outcome. The freedom to go outdoors or have access to extra space should be an important component of the environmental design and care philosophy for the acute admission of people who experience dementia and associated psychiatric and behavioral disturbance.

Objective: To determine the outcome of treatments for vocally disruptive behaviour (VDB) in nursing homes provided by psychogeriatric and geriatric outreach services. Method: Nursing home residents referred to six psychogeriatric and geriatric outreach services for treatment of VDB were examined pre‐ treatment and followed‐up for three months by a research nurse. All recommended treatments for VDB and the effects of implementation were recorded. Main outcome measures were the Cornell Scale for Depression in Dementia, the Dementia Behaviour Disturbance Scale and measures of nurse satisfaction. Results: Three‐month outcome data was available for 22 residents, of whom four had died. Of the remainder, six (33%) had objective improvement in VDB. The nursing home staff rated the outreach teams as at least ‘somewhat’ helpful in 61% of cases surviving three months and was particularly satisfied with medication advice. No specific treatment appeared to be more effective. Conclusions: Reduction in VDB obtained through interventions by psychogeriatric and geriatric outreach teams was modest, but nursing home staff found most of the teams to be helpful. Aged care outreach services should provide support to nursing home staff in the management of challenging behaviours.

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