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Vocally disruptive behaviour in nursing home residents in Ireland: a descriptive study
Published online by Cambridge University Press: 16 December 2020
Abstract
Background:
Vocally disruptive behaviour (VDB) is relatively common in nursing home residents but difficult to treat. There is limited study on prevalence and treatment of VDB. We hypothesise that VDB is a result of complex interaction between patient factors and environmental contributors.
Methods:
Residents of nursing homes in south Dublin were the target population for this study. Inclusion criteria were that the residents were 65 years or over and exhibited VDB significant enough for consideration in the resident’s care plan. Information on typology and frequency of VDB, Interventions employed and their efficacy, diagnoses, Cohen-Mansfield Agitation Inventory scores, Mini-Mental State Examination scores, and Barthel Index scores were obtained.
Results:
Eight percent of nursing home residents were reported to display VDB, most commonly screaming (in 39.4% of vocally disruptive residents). VDB was associated with physical agitation and dementia; together, these two factors accounted for almost two-thirds of the variation in VDB between residents. One-to-one attention, engaging in conversation, redirecting behaviour, and use of psychotropic medication were reported by nurses as the most useful interventions. Analgesics were the medications most commonly used (65.7%) followed by quetiapine (62.9%), and these were reportedly effective in 82.6% and 77.2% of residents respectively.
Conclusions:
VDB is common, challenging, and difficult to manage. The study of VDB is limited by a variety of factors that both contribute to this behaviour and make its treatment challenging. Issues relating to capacity and ethics make it difficult to conduct randomised controlled trials of treatments for VDB in the population affected.
Keywords
- Type
- Original Research
- Information
- Copyright
- © The Author(s), 2020. Published by Cambridge University Press on behalf of The College of Psychiatrists of Ireland
References
Alexopoulos, G, Abrams, R, Young, R, Shamoian, C (1988). Cornell scale for depression in dementia. Biological Psychiatry 23, 271–284.CrossRefGoogle ScholarPubMed
Bagley, H, Cordingley, L, Burns, A, Mozley, CG, Sutcliffe, C, Challis, D, Huxley, P (2000). Recognition of depression by staff in nursing and residential homes. Journal of Clinical Nursing 9, 445–450.CrossRefGoogle ScholarPubMed
Ballard, C, Smith, J, Corbett, A, Husebo, B, Aarsland, D (2011). The role of pain treatment in managing the behavioural and psychological symptoms of dementia (BPSD). International Journal of Palliative Nursing 17, 420–424.CrossRefGoogle ScholarPubMed
Bang, J, Price, D, Prentice, G, Campbell, J (2008). ECT treatment for two cases of dementia-related pathological yelling. The Journal of Neuropsychiatry and Clinical Neurosciences 20, 379–380.10.1176/jnp.2008.20.3.379CrossRefGoogle ScholarPubMed
Beck, C, Frank, L, Chumbler, NR, O’Sullivan, P, Vogelpohl, TS, Rasin, J, Walls, R, Baldwin, B (1998). Correlates of disruptive behavior in severely cognitively impaired nursing home residents. The Gerontologist 38, 189–198.CrossRefGoogle ScholarPubMed
Beck, C, Richards, K, Lambert, C, Doan, R, Landes, R, Whall, A, Algase, D, Kolanowski, A, Feldman, Z (2011). Factors associated with problematic vocalizations in nursing home residents with dementia. The Gerontologist 51, 389–405.CrossRefGoogle ScholarPubMed
Beck, C, Vogelpohl, TS (1999). Problematic vocalizations in institutionalized individuals with dementia. Journal of Gerontological Nursing 25, 17–26.CrossRefGoogle ScholarPubMed
Burgio, LD, Park, NS, Hardin, JM, Sun, F (2007). A longitudinal examination of agitation and resident characteristics in the nursing home. The Gerontologist 47, 642–649.CrossRefGoogle ScholarPubMed
Burgio, L, Scilley, K, Hardin, JM, Hsu, C, Yancey, J (1996). Environmental “White Noise”: an intervention for verbally agitated nursing home residents. The Journals of Gerontology, Series B 51B, 364–373.CrossRefGoogle Scholar
Burrows, AB, Satlin, A, Salzman, C, Nobel, K, Lipsitz, LA (1995). Depression in a long-term care facility: clinical features and discordance between nursing assessment and patient interviews. Journal of the American Geriatrics Society 43, 1118–1122.CrossRefGoogle Scholar
Cariaga, J, Burgio, L, Flynn, W, Martin, D (1991). A controlled study of disruptive vocalizations among geriatric residents in nursing homes. Journal of the American Geriatrics Society 39, 501–507.10.1111/j.1532-5415.1991.tb02497.xCrossRefGoogle ScholarPubMed
Carrion, C, Aymerich, M, Baillés, E, López-Bermejo, A (2013). Cognitive psychosocial intervention in dementia: a systematic review. Dementia and Geriatric Cognitive Disorders 36, 363–375.CrossRefGoogle ScholarPubMed
Central Statistics Office (2017). Vital Statistics Yearly Summary 2016. (www.cso.ie/en/releasesandpublications/ep/pvsys/vitalstatisticsyearlysummary2016). 25 September 2019.Google Scholar
Chou, K, Kaas, M, Richie, M (1996). Assaultive behavior in geriatric patients. Journal of Gerontological Nursing 22, 30–38.CrossRefGoogle ScholarPubMed
Cohen, CI, Hyland, K, Kimhy, D (2003). The utility of mandatory depression screening of dementia patients in nursing homes. American Journal of Psychiatry 160, 2012–2017.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J (1986). Agitated behaviors in the elderly: II. Preliminary results in the cognitively deteriorated. Journal of the American Geriatrics Society 34, 722–727.10.1111/j.1532-5415.1986.tb04303.xCrossRefGoogle ScholarPubMed
Cohen-Mansfield, J (2001). Non-pharmacologic interventions for inappropriate behaviors in dementia: a review, summary, and critique. American Journal of Geriatric Psychiatry 9, 361–381.CrossRefGoogle Scholar
Cohen-Mansfield, J, Libin, A (2005). Verbal and physical non-aggressive agitated behaviors in elderly persons with dementia: robustness of syndromes. Journal of Psychiatric Research 39, 325–332.10.1016/j.jpsychires.2004.08.009CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J, Marx, MS, Rosenthal, AS (1989). A description of agitation in a nursing home. Journal of Gerontology 44, M77–M84.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J, Werner, P, Marx, MS (1990). Screaming in nursing home residents. Journal of the American Geriatrics Society 38, 785–792.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J, Werner, P (1997). Management of verbally disruptive behaviors in nursing home residents. The Journals of Gerontology Series A Biological Sciences and Medical Sciences 52A, M369–M377.CrossRefGoogle Scholar
Collin, C, Wade, DT, Davies, S, Horne, V (1988). The Barthel ADL Index: a reliability study. International Disability Studies 10, 61–63.CrossRefGoogle ScholarPubMed
Cubit, K, Farrell, G, Robinson, A, Myhill, M (2007). A survey of the frequency and impact of Behaviours of Concern in dementia on residential aged care staff. Australasian Journal on Ageing 26, 64–70.10.1111/j.1741-6612.2007.00217.xCrossRefGoogle Scholar
Douglas, S, James, I, Ballard, C (2004). Non-pharmacological interventions in dementia. Advances in Psychiatric Treatment 10, 171–177.CrossRefGoogle Scholar
Draper, B, Snowdon, J, Meares, S, Turner, J (2000). Case-controlled study of nursing home residents referred for treatment of vocally disruptive behavior. International Psychogeriatrics 12, 333–344.CrossRefGoogle ScholarPubMed
Dwyer, M, Byrne, GJA (2000). Disruptive vocalization and depression in older nursing home residents. International Psychogeriatrics 12, 463–471.CrossRefGoogle ScholarPubMed
Enatsu, R, Hantus, S, Gonzalez-Martinez, J, So, N (2011). Ictal singing due to left frontal lobe epilepsy: a case report and review of the literature. Epilepsy Behavior 22, 404–406.CrossRefGoogle ScholarPubMed
Eustace, A, Kidd, N, Greene, E, Fallon, C, Bhrain, SN, Cunningham, C, Coen, R, Walsh, JB, Coakley, D, Lawlor, BA (2001). Verbal aggression in Alzheimer’s disease. Clinical, functional and neuropsychological correlates. International Journal of Geriatric Psychiatry 16, 858–861.10.1002/gps.410CrossRefGoogle ScholarPubMed
Friedman, R, Gryfe, CI, Tal, DT, Freedman, M (1992). The noisy elderly patient: prevalence, assessment, and response to the antidepressant doxepin. Topics in Geriatrics 5, 187–191.Google Scholar
Gruber-Baldini, AL, Zimmerman, S, Boustani, M, Watson, LC, Williams, CS, Reed, PS (2005). Characteristics associated with depression in long-term care residents with dementia. The Gerontologist 45, 50–55.CrossRefGoogle ScholarPubMed
Husebo, BS, Ballard, C, Sandvik, R, Nilsen, OB, Aarsland, D (2011). Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: cluster randomised clinical trial. British Medical Journal 343.CrossRefGoogle ScholarPubMed
Husebo, BS, Ostelo, RWJG, Strand, LI (2014). The MOBID-2 pain scale: reliability and responsiveness to pain in patients with dementia. European Journal of Pain 18, 1419–1430.CrossRefGoogle ScholarPubMed
Jeste, DV, Lacro, JP (2000). Characteristics of an ideal drug for behavioral and psychological symptoms of dementia. International Psychogeriatrics 12, 213–215.CrossRefGoogle Scholar
Keene, J, Hope, T, Fairburn, CG, Jacoby, R, Gedling, K, Ware, CJG (1999). Natural history of aggressive behaviour in dementia. International Journal of Geriatric Psychiatry 14, 541–548.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
Lanovaz, MJ, Sladeczek, IE, Rapp, JT (2011). Effects of music on vocal stereotypy in children with autism. Journal of Applied Behavior Analysis 44, 647–651.CrossRefGoogle ScholarPubMed
Leonard, R, Tinetti, ME, Allore, HG, Drickamer, MA (2006). Potentially modifiable resident characteristics that are associated with physical or verbal aggression among nursing home residents with dementia. Archives of Internal Medicine 166, 1295–1300.CrossRefGoogle ScholarPubMed
Locke, JM, Mudford, OC (2010). Using music to decrease disruptive vocalizations in a man with dementia. Behavioral Interventions 25, 253–260.Google Scholar
Matson, J, Sipes, M, Horovitz, M, Worley, J, Shoemaker, M, Kozlowski, A (2011). Behaviors and corresponding functions addressed via functional assessment. Research in Developmental Disabilities 32, 625–629.CrossRefGoogle ScholarPubMed
Magri, CJ, Ferry, P, Abela, S (2007). A review of the aetiology and management of vocal behaviour in dementia. Malta Medical Journal 19, 30–35.Google Scholar
Matteau, E, Landreville, P, Laplante, L, Laplante, C (2003). Disruptive vocalizations: a means to communicate in dementia?. American Journal of Alzheimer’s Disease & Other Dementias 18, 147–153.CrossRefGoogle ScholarPubMed
McCarthy, B, Boland, A, Murphy, S, Cooney, C (2019). Vocally disruptive behavior: a case report and literature review. Irish Journal of Psychological Medicine 1–6. doi: 10.1017/ipm.2019.18Google ScholarPubMed
Menon, AS, Gruber-Baldini, AL, Hebel, JR, Kaup, B, Loreck, D, Zimmerman, SI, Burton, L, German, P, Magaziner, J (2001). Relationship between aggressive behaviors and depression among nursing home residents with dementia. International Journal of Geriatric Psychiatry 16, 139–146.10.1002/1099-1166(200102)16:2<139::AID-GPS284>3.0.CO;2-53.0.CO;2-5>CrossRefGoogle ScholarPubMed
Nagaratnam, N, Patel, I, Whelan, C (2003). Screaming, shrieking and muttering: the noise-makers amongst dementia patients. Archives of Gerontology and Geriatrics 36, 247–258.CrossRefGoogle ScholarPubMed
O’Neil, ME, Freeman, M, Christensen, V, Telerant, R, Addleman, A, Kansagara, D (2011). A Systematic Evidence Review of Non-pharmacological Interventions for Behavioral Symptoms of Dementia. Department of Veterans Affairs: Washington, DC.Google ScholarPubMed
Pomara, N, Volavka, J, Czobor, P, Hernando, R, Sidtis, JJ (2005). Screaming and physical aggression in nursing homes. American Journal of Geriatric Psychiatry 13, 539–540.CrossRefGoogle ScholarPubMed
Rosin, AJ (1977). The physical and behavioral complex of dementia. Gerontology 23, 37–46.CrossRefGoogle ScholarPubMed
Rovner, BW, Kafonek, S, Filipp, L, Lucas, MJ, Folstein, MF (1986). Prevalence of mental illness in a community nursing home. The American Journal of Psychiatry 143, 1446–1449.Google Scholar
Schreiner, A (2001). Aggressive behaviors among demented nursing home residents in Japan. International Journal of Geriatric Psychiatry 16, 209–215.3.0.CO;2-9>CrossRefGoogle ScholarPubMed
Schneider, LS, Dagerman, K, Insel, PS (2006). Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. The American Journal of Geriatric Psychiatry 14, 191–210.CrossRefGoogle ScholarPubMed
Sloane, PD, Davidson, S, Buckwalter, K, Lindsey, BA, Ayers, S, Lenker, V, Burgio, LD (1997). Management of patient with disruptive vocalization. The Gerontologist 37, 675–682.Google ScholarPubMed
Sloane, PD, Mitchell, CM, Preisser, JS, Phillips, C, Commander, C, Burker, E (1998). Environmental correlates of resident agitation in Alzheimer’s disease special care units. Journal of the American Geriatrics Society 46, 862–869.10.1111/j.1532-5415.1998.tb02720.xCrossRefGoogle ScholarPubMed
Strøm, BS, Ytrehus, S, Grov, EK (2016). Sensory stimulation for persons with dementia: a review of the literature. Journal of Clinical Nursing 25, 1805–1834.CrossRefGoogle ScholarPubMed
Teresi, J, Abrams, R, Holmes, D, Ramirez, M, Eimicke, J (2001). Prevalence of depression and depression recognition in nursing homes. Social Psychiatry and Psychiatry Epidemiology 36, 613–620.CrossRefGoogle ScholarPubMed
Testad, I, Aasland, AM, Aarsland, D (2007). Prevalence and correlates of disruptive behavior in patients in Norwegian nursing homes. International Journal of Geriatric Psychiatry 22, 916–921.CrossRefGoogle ScholarPubMed
Vance, DE, Burgio, LD, Roth, DL, Stevens, J, Fairchild, F, Yurick, A (2003). Predictors of agitation in nursing home residents. Journal of Gerontology 58B, 129–137.CrossRefGoogle Scholar
von Gunten, A, Alnawaqil, A-M, Abderhalden, C, Needham, I, Schupbach, B (2008). Vocally disruptive behavior in the elderly: a systematic review. International Psychogeriatrics 20, 653–672.CrossRefGoogle ScholarPubMed
Von Gunten, A, Favre, M, Gurtner, C, Abderhalden, C (2011). Vocally Disruptive Behavior (VDB) in the institutionalized elderly: a naturalistic multiple case report. Archives of Gerontology and Geriatrics 52, 110–116.10.1016/j.archger.2010.08.008CrossRefGoogle ScholarPubMed
Voyer, P, Verreault, R, Azizah, GM, Desrosiers, J, Champoux, N, Bédard, A (2005). Prevalence of physical and verbal aggressive behaviours and associated factors among older adults in long-term care facilities. BMC Geriatrics 5.CrossRefGoogle ScholarPubMed
Whall, A, Gillis, G, Yankou, D, Booth, D, Beel-Bates, C (1992). Disruptive behavior in elderly nursing home residents: a survey of nursing staff. Journal of Gerontological Nursing 18, 13–17.CrossRefGoogle ScholarPubMed
Wilson, NL, Sloane, PD, Davidson, S, Buckwalter, K, Lindsey, BA, Ayers, S, Lenker, V, Burgio, LD (1997). Management of the patient with disruptive vocalization. The Gerontologist 37, 675–682.CrossRefGoogle Scholar
Zeisel, J, Silverstein, NM, Hyde, J, Levkoff, S, Lawton, MP, Holmes, W (2003). Environmental correlates to behavioral health outcomes in Alzheimer’s special care units. The Gerontologist 43, 697–711.CrossRefGoogle ScholarPubMed