Behavioral Intensive Care Unit (BICU): A New Concept in the Management of Acute Agitated Behavior in Elderly Demented Patients

Mintzer, Jacobo; Lewis, Linda L.; Pennypaker, Leslye; Simpson, William M.; Bachman, David; Wohlreich, George; Meeks, A; Hunt, Steven R.; Sampson, Royce

doi:10.1093/geront/33.6.801

Cited by 31 publications

(11 citation statements)

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“…An implication of the present results is that interventions which improve behavioral symptoms of AD without improving cognition (Mintzer et al, 1993) may signi®cantly improve the quality of life for the AD victim and reduce caregiver burden but will do so without much impact on the patient's ability to perform ordinary ADLs. Fully eective management of AD patients will involve treatment programs that improve both cognitive and noncognitive behavioral disturbances.…”

Section: Discussionmentioning

confidence: 86%

The impact of behavioral impairment of functional ability in Alzheimer's disease

Green

Marin

Mohs

et al. 1999

Int. J. Geriat. Psychiatry

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This study sought to determine the relationship between behavioral disturbance and functional status in a longitudinally studied sample of patients with Alzheimer's disease (AD). One hundred and forty‐nine patients meeting NINCDS–ADRDA criteria for probable AD were followed for an average of 37.3 months, with follow‐up assessments every 6 months. Subjects were seen at the Alzheimer's Disease Research Center clinics at the Mt Sinai Medical Center, New York, and the Veterans Affairs Medical Center, Bronx, New York. Measures included the Physical and Self‐Maintenance Scale (PSMS) and Instrumental Activities of Daily Living Scale (IADLS) of Lawton and Brody and the cognitive and non‐cognitive subscales of the Alzheimer's Disease Assessment Scale (ADAS). For each patient the assessment at which they had their most severe non‐cognitive symptoms as measured by the non‐cognitive part of the ADAS (ADAS‐NC) was determined. ADAS‐NC scores at that assessment were correlated with IADLS and PSMS scores at the same assessment and at the next assessment 6 months later. While there was some modest association of ADAS‐NC scores with functional impairment using pairwise correlation coefficients, none of the correlations remained significant when the severity of cognitive impairment was controlled statistically. Findings were not significantly changed when drug status was controlled. These results suggest that behavioral disturbance, while very troubling to caregivers and patients, does not substantially worsen functional ability beyond the contribution of cognitive impairment in AD. Together with previous results indicating that non‐cognitive symptoms in AD are episodic and fluctuating rather than progressive, the present data suggest that interventions for non‐cognitive disturbances in AD should be viewed as ways to increase patient comfort, safety and ease of care and not as ways to improve functional autonomy. The latter can be achieved only by improving the progressive cognitive deficits of AD. Copyright © 1999 John Wiley & Sons, Ltd.

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Section: Discussionmentioning

confidence: 86%

The impact of behavioral impairment of functional ability in Alzheimer's disease

Green

Marin

Mohs

et al. 1999

Int. J. Geriat. Psychiatry

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“…This study is unique in that it evaluates the ef cacy of a continuum of care program for family caregivers whose AD af icted elders' disruptive behaviors were rst stabilized in an inpatient setting, that is, a Behavioral Intensive Care Unit (BICU) specializing in geriatric care (Mintzer et al, 1993). Following discharge from the BICU to a family caregiver's home, a nurse education and counseling program provided continuum of care for a period of one year.…”

mentioning

confidence: 99%

Continuum of Care for Alzheimer's Disease: A Nurse Education and Counseling Program

Wright

Litaker²,

Laraia³

et al. 2001

Issues in Mental Health Nursing

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This study evaluated a one year long course education and counseling program with 93 family caregivers of elders afflicted with Alzheimer's disease. The elders had received treatment for agitation in an inpatient setting and were subsequently discharged to the caregivers' home. Caregivers were randomly assigned to an experimental group (n = 68) and a control group (n = 25). Baseline assessments (Time 0) were conducted while the elder was an inpatient. Postdischarge interventions and assessments were conducted at 2 weeks, 6 weeks, 12 weeks, and 6 and 12 months (Times 1-5 respectively). There were no significant treatment effects for care recipient agitation, caregiver stress, depression, and physical health, and no significant differences between groups in rates of institutionalization for afflicted elders. Longitudinal data, however, revealed several important trends. Afflicted elders' agitation rose steadily for control group subjects at Times 3 through 5 but declined for experimental group subjects. Caregiver depression increased for control group subjects at Time 5, but declined for experimental group subjects. Caregiver physical health declined for control group subjects at Times 4 and 5 but was maintained for experimental group subjects. A significantly higher number of afflicted elders were still at home among experimental group subjects at the end of the one year study. The difficulties in demonstrating efficacy of interventions with family caregivers of Alzheimer's disease are discussed. Finally, the issue of data collection being perceived as support by control group subjects is evaluated.

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“…For example, those with hallucinations benefited more from the videotape of family members talking to them, whereas those who were requesting attention benefited most from the one-on-one social interaction. Several articles describe individualized approaches to treating behavioral problems (51)(52)(53).…”

Section: Individualization Of Treatmentmentioning

confidence: 99%

Nonpharmacologic Interventions for Inappropriate Behaviors in Dementia: A Review, Summary, and Critique

Cohen‐Mansfield

2004

FOC

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Inappropriate behaviors are very common in dementia and impose an enormous toll both emotionally and financially. These behaviors increase suffering for the person with dementia and burden for caregivers; they prompt utilization of more restrictive care, and result in the application of both pharmacologic and nonpharmacologic treatments. For the purpose of this article, inappropriate behaviors will be defined as "inappropriate verbal, vocal, or motor activity that is not judged by an outside observer to be an obvious outcome of the needs or confusion of the individual" (1). These behaviors have been labeled problem behaviors, disruptive behaviors, disturbing behaviors, behavioral problems, and agitation, all of which are used interchangeably in this article. Inappropriate behaviors may result from depressed affect, but the term refers specifically to observable behavior, rather than internal states. Similarly, delusions and hallucinations are only included to the extent that these are manifested as inappropriate behavior; the core manifestation (i.e., the misinterpretation of reality) is not. Inappropriate behaviors have been divided into four main subtypes (2): 1) physically aggressive behaviors, such as hitting, kicking or biting; 2) physically nonaggressive behaviors, such as Inappropriate behaviors are very common in dementia and impose an enormous toll both emotionally and financially. Three main psychosocial theoretical models have generally been utilized to explain inappropriate behaviors in dementia: the "unmet needs" model, a behavioral/learning model, and an environmental vulnerability/reduced stress-threshold model. A literature search yielded 83 nonpharmacological intervention studies, which utilized the following categories of interventions: sensory, social contact (real or simulated), behavior therapy, staff training, structured activities, environmental interventions, medical/nursing care interventions, and combination therapies. The majority are reported to have a positive, albeit not always significant, impact. Better matching of the available interventions to patients' needs and capabilities may result in greater benefits to patients and their caregivers.

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Behavioral Intensive Care Unit (BICU): A New Concept in the Management of Acute Agitated Behavior in Elderly Demented Patients

Cited by 31 publications

References 0 publications

The impact of behavioral impairment of functional ability in Alzheimer's disease

The impact of behavioral impairment of functional ability in Alzheimer's disease

Continuum of Care for Alzheimer's Disease: A Nurse Education and Counseling Program

Nonpharmacologic Interventions for Inappropriate Behaviors in Dementia: A Review, Summary, and Critique

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