A Controlled Study of Disruptive Vocalizations among Geriatric Residents in Nursing Homes

Abstract

This paper reports the results of a controlled study comparing geriatric residents in nursing homes who displayed disruptive vocalizations with residents in a comparison group. Two 350-bed nursing homes were surveyed, and it was found that 11% of the residents engaged in disruptive vocalizations, at least once per week, of sufficient severity to require consideration in the resident's care plan. Results show that disruptive vocalizers were more functionally impaired and were more likely to receive a diagnosis of dementia. They were also more likely to display a higher activity level and to experience sleep disturbance and to be prescribed neuroleptic medications. Descriptive data are presented on typology of disruptive vocalizations, likely situations for their occurrence, and the utilization and perceived efficacy of common interventions. Suggestions are made regarding behavioral treatments for this vexing problem.

Agitated behavior in persons with dementia: The relationship between type of behavior, its frequency, and its disruptiveness

“…For example, in an observational study of 175 elderly persons with dementia, CohenMansfield and Libin (2005) found verbally agitated behaviors to be associated with female gender, cognitive decline, poor ADL performance, impaired social functioning, and depressed affect. These findings corroborated those of previous studies (Cariaga et al, 1991;CohenMansfield et al, 1992). Physically non-aggressive behaviors were positively related to cognitive impairment and negatively related to number of concurrent medical diagnoses.…”

Assessment and measurement of pain in older adults

“…An alternative approach is the evaluation of behavioral manifestations of pain. [16] [100] and investigators have demonstrated that observational methods of evaluating pain behaviors are psychometrically sound when used with the general population (e.g., acute pain, communicative patients with chronic lower back pain, and osteoarthritic knee pain) and that the behaviors are sensitive to treatment effects. [73] [121] The utility and validity of these approaches with cognitively impaired older adults, however, has yet to be determined.…”

Vocally disruptive behavior in the elderly: a systematic review

“…Unsurprisingly, frequency estimations depend on how VDB is defined. Thus, breaking down VDB, the frequency of screaming was found in 51% of VDB, abusive language in 37%, moaning in 33%, repetitive verbalizations in 25%, and other vocalizations in 17% (Cariaga et al, 1991). Similarly, frequencies varied depending on the presumed etiology of VDB: purposeless and persistent noisemaking in 9% to 10.4% of cases, noise-making as a response to the environment in 6.5% to 9.4%, noise-making that appears directed towards eliciting a response from the environment in 3.9% to 7%, "chatterbox" noise-making in 1.6% to 2.8%, noise-making in the context of deafness in 1.2% to 1.4%, and other noisemaking in 2.5% to 4.4% (Ryan et al, 1988).…”

“…VDB may therefore reflect an underlying need to communicate discomfort due to pain, thirst, hunger, and inappropriate room temperature which may be undetected or ignored by staff (McMinn and Draper, 2005) or be the response to inappropriate mental or physical stimuli (Draper et al, 2000). Indeed, patients in nursing homes with VDB were prescribed analgesic drugs less often than those without VDB (Cariaga et al, 1991). Furthermore, caregivers' attitudes towards nursing home patients may well be one of the causes of disruptive behaviors since communication may reflect attitudes held towards a patient (Burgener et al, 1992).…”

“…Alois Alzheimer's patient had VDB as she screamed loudly (Alzheimer, 1907), but other descriptions have since been added and include, besides screaming, shouting, yelling, howling, talking constantly, permanent requests for attention and help, repeating phrases or words, repetitive verbalizations, repetitious noises, groaning, singing loudly, nonsense talking, verbal aggression, making threats implying harm to others or self, abusive or accusatory or hostile or obscene or profane language, complaining, and cursing. These behaviors may all be considered as VDB (Cariaga et al, 1991;Beck et al, 1998;Draper et al, 2000). Further variants of VDB are continuous chattering, muttering, singing or humming, grunting, and bizarre noise-making that can be observed in people with severe dementia (Nagaratnam et al, 2003b).…”