Integrative review: Persistent vocalizations among nursing home residents with dementia

ABSTRACTBackground:Nursing home (NH) residents with dementia commonly exhibit persistent vocalizations (PVs), otherwise known in the literature as disruptive or problematic vocalizations. Having a better understanding of PVs and the research completed to date on this phenomenon is important to guide further research and clinical practice in NHs. This integrative review examines the current literature on the phenomenon of PVs among NH residents with dementia.

METHODS

We conducted a search in the PubMed, Scopus, Ovid Medline, and CINAHL databases for articles published in English. Articles were included if the focus was specifically on research involving vocal behaviors of older adults with dementia residing in NHs.

RESULTS

Our literature search revealed eight research articles that met the inclusion criteria. These studies were published in 2011 or earlier and involved small sample sizes. Seven of these studies were descriptive and the eighth was a non-pharmacological intervention study for PVs exhibited by NH residents with dementia. These studies were vastly different in their labeling, definitions, and categorization of the PVs as well as methods of measuring PVs.

CONCLUSION

The heterogeneity of the evidence limits the ability to make recommendations for practice. Given the paucity of research on this phenomenon; recommendations for additional research are given.

The effect of a lollipop on vocally disruptive behavior in a patient with frontotemporal dementia: a case-study

A problematic and disturbing behavior which can develop in people with dementia, is vocally disruptive behavior (VDB). To date, the study of VDB is underdeveloped and with only a limited knowledge base. Medications commonly used in VDB have limited benefits and specific risks in patients with dementia. This report details the case of a patient with frontotemporal dementia with VDB, which responded very well by providing a lollipop. Subsequently, we pose theory-based hypotheses in order to try to explain the beneficial effect of this intervention. This may contribute to a better understanding of VDB and possible treatment strategies.

Review: verbal agitation in dementia: the role of discomfort

Verbal agitation (VA) is a disturbing and commonly observed behavioral symptom in people with dementia. Although several different variables contribute to VA, it seems that discomfort plays an important role. The overall objective of this article is to review the relationship between VA and discomfort among people with dementia. Specifically, this article discusses the place of discomfort within the conceptualizations of VA, empirical support for the association between discomfort and VA, and practical implications of this relationship in the assessment and treatment of VA. This article contributes to a better understanding of VA and provides recommendations for prevention and effective intervention.

Étude préliminaire d'une intervention non-pharmacologique pour réduire l'agitation verbale chez les personnes atteintes de démence

Verbally agitated behaviours are among the behavioural symptoms of dementia most commonly encountered in long-term care facilities. These behaviours may be related to unmet needs that cannot be expressed adequately because of cognitive impairment. The objective of this preliminary study is to assess an intervention, based on the needs of social attention, sensory stimulation, and comfort, for managing verbally agitated behaviours in long-term care demented patients. A multiple baseline case study design was used, with two participants.

Screaming in elderly persons with dementia

This article presents a critical review of empirical data to guide knowledge development of screaming in elderly persons with dementia. Many reasons have been identified for why humans and animals scream. Studies on elderly populations have focused mostly on factors associated with screaming. Also, a vast selection of interventions for elderly persons with dementia who scream has been tested, but there is little evidence of their efficacy. Better knowledge of screaming in this population is needed. In particular, the meaning of this behaviour must be determined and stronger evidence of the efficacy of interventions must be acquired. In order to develop helpful clinical interventions, it is suggested that diverse research methods be used and that the perspective of all actors involved be considered, including that of the elderly persons, their families and their professional caregivers.

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

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.

Disruptive vocalizations: a means to communicate in dementia?

Disruptive vocalizations (DVs) constitute a serious problem in geriatric nursing homes. The current literature suggests that DV can be interpreted as a way for demented persons with language limitations to communicate with others. In an attempt to test this hypothesis, 59 participants were recruited from six nursing homes to form two groups: one group of individuals with preserved language skills (PLS) and another group with altered language skills (ALS). They were compared on the frequency and types of DV. The results indicate that individuals with ALS manifest DV at a greater frequency than those with PLS. These persons also present a greater number of distinct DV forms. The results are interpreted in terms of language deterioration associated with dementia.