Disruptive Vocalization and Depression in Older Nursing Home Residents

Abstract

Screaming and other types of disruptive vocalization are commonly observed among nursing home residents. Depressive symptoms are also frequently seen in this group, although the relationship between disruptive vocalization and depressive symptoms is unclear. Accordingly, we sought to examine this relationship in older nursing home residents. We undertook a controlled comparison of 41 vocally disruptive nursing home residents and 43 non-vocally-disruptive nursing home residents. All participants were selected to have Mini-Mental State Examination (MMSE) scores of at least 10. Participants had a mean age of 81.0 years (range 63-97 years) and had a mean MMSE score of 17.8 (range 10-29). Nurse ratings of disruptive vocalization according to a semioperationalized definition were validated against the noisy behavior subscale of the Cohen-Mansfield Agitation Inventory. Subjects were independently rated for depressive symptoms by a psychiatrist using the Dementia Mood Assessment Scale, the Cornell Scale for Depression in Dementia, and the Depressive Signs Scale. Vocally disruptive nursing home residents scored significantly higher than controls on each of these three depresion-in-dementia scales. These differences remained significant when the effects of possible confounding variables of cognitive impairment, age, and sex were removed. We conclude that depressive symptoms are associated with disruptive vocalization and may have an etiological role in the generation of disruptive vocalization behaviors in elderly nursing home residents.

Agitation in Dutch Institutionalized Patients with Dementia: Factor Analysis of the Dutch Version of the Cohen-Mansfield Agitation Inventory

“…The exact mechanisms inducing vocal agitation are yet unknown [45] but might be explained by interruption of the frontal subcortical circuits [35] . Vocal agitation has also been associated with severe cognitive impairment [46] or severe dementia with total dissolution of speech [35] , depression [47,48] , psychosis [48] , undertreated pain [46,48] or environmental factors such as noise levels or over/understimulation [48,49] . There may be different types of disruptive vocalizations [44] .…”

The management of inappropriate vocalisation in dementia: a hierarchical approach

“…Both psychosis and depressive features have been found to be more prevalent in nursing home patients with inappropriate vocalisation (Lyo et al, 1996). The use of three depression-in-dementia scales concurred with the above findings and the authors went on to consider the link between inappropriate vocalisation and depressive symptoms (Dwyer and Byrne, 2000). Firstly, could such vocalisation cause depression?…”

“…Inappropriate vocalisation is associated with severe cognitive impairment (Cariaga et al, 1991) and patients with dementia have decreased serotonin levels in their brain (Jellinger, 1996). It may be that this disorder of serotonergic function contributes not only to depression in those with dementia (Zweig et al, 1988) but also to reduced impulse control and the development of inappropriate vocalisation (Dwyer and Byrne, 2000). Serotonergic treatment would therefore seem a 'rationally empirical' option.…”

Impact of Underlying Depression on Treatment of Neuropsychiatric Symptoms in Older Adults with Dementia

“…Use of psychoactive medication for agitation is common and in most cases sedates individuals with distress, whereas the interdisciplinary team approach that focuses on engaging individuals earlier in the day provides an alternative that aligns with current nursing home survey standards (Buettner & Buckwalter, 2006). Dwyer and Byrne (2000) found depressive symptoms were associated with disruptive vocalization in nursing home residents, one of the most problematic forms of agitation (Sloane, Davidson, Knight, Tangen, & Mitchell, 1999). In our study, we provided carefully planned recreation therapy during periods of passivity, with the goal of engaging residents in meaningful experiences.…”