The management of inappropriate vocalisation in dementia: a hierarchical approach

Barton, Sue; Findlay, D.J.S.; Blake, Roger A.

doi:10.1002/gps.1416

Cited by 36 publications

(35 citation statements)

References 37 publications

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“…The repeated appeal to return home tends to occur during the busiest evening hours in nursing facilities (Barton et al 2005;Zaraa 2003). Care workers prepare residents' tables for supper and shift their work between the day and the night workers.…”

Section: Resultsmentioning

confidence: 98%

“…Unfortunately, their experiential learning is often concealed below the level of consciousness: it has not been accumulated as usable knowledge, nor has it been articulated in a way that can be shared with other workers. The approach to BPSD among care workers has been trapped in a "trial and error" type of practice (Barton et al 2005;Clavel 1999;Hutchinson et al 1996;Smith et al 2004) which seldom benefits from the expertise of long-time formal caregivers.…”

Section: Introductionmentioning

confidence: 99%

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The Repeated Appeal to Return Home in Older Adults with Dementia: Developing a Model for Practice

Fukui¹,

Okada

Nishimoto³

et al. 2010

J Cross Cult Gerontol

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Dementia care has been trapped in a "trial and error" type of practice due to difficulty understanding the needs of older adults with severe dementia. Behavioral and Psychological Signs and Symptoms of Dementia (BPSD) can be quite difficult for residential staff. However, some experienced care workers succeed in establishing effective relationships. The goal of this study was to: 1) develop a process to identify needs behind BPSD; 2) find solutions using a team approach; and 3) apply the results to educate new workers. The KJ method was employed to reach decision-making about best practices in residential dementia care. This qualitative method is used to organize group data collected in the field and is based on understanding complex situations. A group process of 12 Japanese care workers experienced in understanding and responding to the "repeated appeal to return home" of residents in nursing care facilities is highlighted along with an illustrative case example. The workgroup met over two years. The study revealed five steps in understanding the needs behind the appeal, which include: (1) Listen to the voice and go with the flow of the behavior; (2) Learn about the inner experience; (3) Learn about the contextual environment of "here and now" situations; (4) Reflect on the care environment; and (5) Find the keyword. This needs identification process has application to other cultural contexts. The implications of this study for practitioners who work with people with dementia in residential settings will be discussed.

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Section: Resultsmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

The Repeated Appeal to Return Home in Older Adults with Dementia: Developing a Model for Practice

Fukui¹,

Okada

Nishimoto³

et al. 2010

J Cross Cult Gerontol

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“…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] .…”

Section: Discussionmentioning

confidence: 99%

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

Zuidema

Jonghe

Verhey

et al. 2006

Dement Geriatr Cogn Disord

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Background/Aims: To establish the construct validity of the Dutch version of the Cohen-Mansfield Agitation Inventory (CMAI-D) in institutionalized patients with dementia. Methods: The CMAI-D was administered to a large sample of 1,437 patients with moderate to severe dementia, receiving nursing home or outreaching nursing home care. Exploratory factor analysis was used to examine the behavioral dimensions underlying CMAI-D observations. Results: A restricted 3-factor solution showed 3 factors, i.e. physical aggression, physically nonaggressive behavior and verbally agitated behavior, with prevalences of 62, 67 and 62%, respectively. An unrestricted factor solution revealed 3 additional behavioral dimensions: hiding/hoarding, vocal agitation and a factor of miscellaneous items (i.e. repetitious mannerisms, spitting), which occurred in 30, 28 and 35% of the patients, respectively. Conclusion: The 3-factor solution of physical aggression, physically nonaggressive behavior and verbally agitated behavior corroborates earlier findings in other patient samples and therefore establishes the construct validity in institutionalized patients with severe dementia. The robustness of these findings across different care settings suggests that agitated behaviors have a common basis. In addition, unrestricted factor analysis showed 3 other important independent behavioral symptoms in dementia, but they are in fact too small to be used as a subscale. These findings might add to the taxonomy of agitation and aggression in dementia.

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“…Research has demonstrated that BEs often arise from incongruence between a person’s needs (e.g., pain/discomfort 6,7 , loneliness/isolation 8 , boredom 9,10 , sensory deprivation 11,12 ) and the degree to which the environment fulfills these needs 13,14 . Consequently, BEs may indicate unmet needs, an inadequate attempt to fill those needs, or a desire for help.…”

mentioning

confidence: 99%

What Are the Barriers to Performing Nonpharmacological Interventions for Behavioral Symptoms in the Nursing Home?

Cohen‐Mansfield¹,

Thein²,

Marx³

et al. 2012

Journal of the American Medical Directors Association

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OBJECTIVE Behavioral symptoms are common in persons with dementia, and nonpharmacological interventions are recommended as the first line of therapy. We describe barriers to conducting nonpharmacological interventions for behavioral symptoms. DESIGN A descriptive study of barriers to intervention delivery in a controlled trial. SETTINGS The study was conducted in 6 nursing homes in Maryland. PARTICIPANTS 89 agitated nursing home residents with dementia. INTERVENTION Personalized interventions were developed using the TREA decision tree protocol. Trained research assistants prepared and delivered the interventions. Feasibility of the interventions was determined. MEASUREMENTS Barriers to Intervention Delivery Assessment (BIDA), ADL, cognitive functioning, depressed affect, pain, observed agitation, and observed affect. RESULTS Barriers were observed for the categories of resident barriers (specifically, unwillingness to participate; resident attributes, such as unresponsive), barriers related to resident unavailability (resident asleep or eating), and for external barriers (staff-related barriers, family-related barriers, environmental barriers, and system process variables). Interventions pertaining to food/drink and to 1-on-1 socializing were found to have the fewest barriers, while higher numbers of barriers occurred with puzzles/board games and arts and crafts activities. Moreover, when successful interventions were presented to participants after the feasibility period, we noted fewer barriers, presumably because barrier identification had been used to better tailor interventions to each participant and to the environment. CONCLUSION Knowledge of barriers provides a tool by which to tailor interventions so as to anticipate or circumvent barriers, thereby maximizing intervention delivery.

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The management of inappropriate vocalisation in dementia: a hierarchical approach

Cited by 36 publications

References 37 publications

The Repeated Appeal to Return Home in Older Adults with Dementia: Developing a Model for Practice

The Repeated Appeal to Return Home in Older Adults with Dementia: Developing a Model for Practice

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

What Are the Barriers to Performing Nonpharmacological Interventions for Behavioral Symptoms in the Nursing Home?

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