Treating severe behavioral disorders in geriatric residential settings

Burgio, Louis D.; Bourgeois, Michelle S.

doi:10.1002/bin.2360070206

Cited by 20 publications

(17 citation statements)

References 75 publications

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“…They expressed the opinion that it would be impractical to maintain a fixed time schedule of reinforcement in the nursing home setting. In summary, because of the financial constraints and staff shortages common in most aged care facilities, interventions must be both easy to use and inexpensive (Burgio & Bourgeois, 1992;Burgio, 1997). Non-contingent reinforcement schedules (Buchanan & Fisher, 2002) might not be practical in residential settings.…”

Section: Psychotropic Medicationmentioning

confidence: 99%

Vocally disruptive behaviour in dementia: Development of an evidence based practice guideline

McMinn¹,

Draper

2005

Aging & Mental Health

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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.

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Section: Psychotropic Medicationmentioning

confidence: 99%

Vocally disruptive behaviour in dementia: Development of an evidence based practice guideline

McMinn¹,

Draper

2005

Aging & Mental Health

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“…This improvement was achieved despite the fact that treatment integrity data revealed the audiotapes were used during only 51% of the observations. (26) The following section of this paper is devoted to interventions and focuses on selected strategies related to management of disruptive behaviors. We begin by identifying general intervention strategies (behavioral, environmental, cognitive and activity-based) and then move to more specific interventions for wandering and agitation, and interventions to reduce restraints.…”

Section: Need For Biobehavioral Interventionsmentioning

confidence: 99%

Managing Cognitive Impairment in the Elderly: Conceptual, Intervention and Methodological Issues

Buckwalter¹,

Stolley²,

Farran³

1999

Worldviews on Evidence-based Nursing presents the archives of O

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Purpose (1) With the aging of society, the incidence of dementia in the elderly is also increasing, and thus results in increased numbers of individuals with cognitive impairment. Nurses and other researchers have investigated issues concerning the management of cognitive impairment. This article highlights conceptual, intervention and methodological issues associated with this phenomenon. Conclusion (2) Cognitive change is a multivariate construct that includes alterations in a variety of information processing mechanisms such as problem solving ability, memory, perception, attention and learning, and judgement. Although there is a large body of research, conceptual, intervention and methodological issues remain. Much of the clinical research on cognitive impairment is atheoretical, with this issue only recently being addressed. While many clinical interventions have been proposed, few have been adequately tested. There are also various methodological concerns, such as small sample sizes and limited statistical power; study design issues (experimental vs. non‐experimental), and internal and external validity problems. Clearly, additional research designed to intervene with these difficult behaviors is needed. Implication (3) A variety of psychosocial, environmental and physical parameters must be considered in the nursing care of persons with cognitive impairment. Special attention has been given to interventions associated with disruptive behaviors. Interventions are complex and knowledge must be integrated from both the biomedical and behavioral sciences in order to deal effectively with the numerous problems that can arise over a long and changing clinical course. Some researchers and clinicians have suggested that a new culture regarding dementia care is needed, one that focuses on changing attitudes and beliefs about persons with dementia and one that changes how organizations deliver that care. This review identifies key conceptual, intervention and methodological issues and recommends how these issues might be addressed in the future.

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“…A meta-analysis that examined the efficacy of pharmacotherapy with AD patients found that only 20% of the patients responded favorably (Schneider, Pollock, & Lynes, 1990), whereas the adverse side effects included sedation, tardive dyskinesia, and memory impairment. More recently, behavioral and environmental interventions and staff training have been recommended as alternative approaches to managing disruptive behaviors (Burgio & Bourgeois, 1992). Ideally, nursing interventions for persons with dementia should be conceptually based and provide specific compensations for the individual's deficits secondary to the disease process.…”

Section: Implications For Psychiatric Nursingmentioning

confidence: 99%

The Biological Basis of Behavioral Symptoms in Dementia

Garand

Buckwalter

Hall

2000

Issues in Mental Health Nursing

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This article describes the pathophysiology of dementia and differentiates between cognitive and noncognitive symptoms that characterize this devastating illness. Relationships between brain anatomic and neurochemical systems and behavioral symptoms of dementia are discussed. An overview of the etiologies and neuropathologiesof dementia are presented as they relate to impairments in memory and intellectual abilities, personality changes, and behavioral symptoms. Recent genetic and molecular discoveries that have advanced our understanding of this complex spectrum of disorders and their treatment(s) are also highlighted.More than 70 diseases/disorders are associated with the progressive loss of memory and intellectual function known as dementia, although Alzheimer's disease (AD) is by far the most common cause. Current estimates suggest that more than four million Americans suffer from AD (Advisory Panel on Alzheimer's Disease, 1995). Although the diagnosis of dementia focuses on the clinical presentation of cognitive deficits, complex disturbances of behavior and emotion have been recognized as part of the disorder since Alois Alzheimer's original case report in 1907 describing the cerebral cortex and abnormal behaviors of a 55-yearold woman (Alzheimer, 1987). In contrast to the cognitive symptoms, which usually follow a welldescribed course of progressive decline, the occurrence and course of the noncognitive symptoms in dementia are less predictable (Tariot, 1994), developing at any stage during the disease process (Eisdorfer et al., 1992).There is a discrepancy between the labeling of symptoms by health care professionals and complaints by family members about their loved one's behavior. For example, dementia is generally defined by clinicians as progressive deterioration of cognitive abilities, however families of dementia patients often define the stages of illness with behavioral (noncognitive) markers. In fact, behavioral complications are a leading cause of institutionalization in persons with dementia (Knopman, Kitto, Deinard, & Heiring, 1988;Steele, Rovner, Chase, & Folstein, 1990).Disease progression is not measured simply by declining scores on the Mini-Mental State Exam or other clinical rating scales, but rather includes such symptoms as the amount of sleeplessness at night, the person's degree of agitation or psychosis, and the level of depressed mood. A key unanswered scientific question is how central these noncognitive behavioral symptoms are to

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Treating severe behavioral disorders in geriatric residential settings

Cited by 20 publications

References 75 publications

Vocally disruptive behaviour in dementia: Development of an evidence based practice guideline

Vocally disruptive behaviour in dementia: Development of an evidence based practice guideline

Managing Cognitive Impairment in the Elderly: Conceptual, Intervention and Methodological Issues

The Biological Basis of Behavioral Symptoms in Dementia

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