Hostname: page-component-848d4c4894-pftt2 Total loading time: 0 Render date: 2024-06-06T16:18:31.831Z Has data issue: false hasContentIssue false
  • English
  • Français

Vocally disruptive behavior in the elderly: a systematic review

Published online by Cambridge University Press:  01 August 2008

Armin von Gunten ,
Abdel-Messieh Alnawaqil ,
Christoph Abderhalden ,
Ian Needham  and
Brigitte Schupbach
Armin von Gunten*
Affiliation:
Service Universitaire de Psychiatrie de l'Age Avancé (SUPAA), Prilly, Switzerland Research Group of the Swiss Society for Old Age Psychiatry
Abdel-Messieh Alnawaqil
Affiliation:
Service Universitaire de Psychiatrie de l'Age Avancé (SUPAA), Prilly, Switzerland
Christoph Abderhalden
Affiliation:
Universitäre Psychiatrische Dienste, Bern, Switzerland Research Group of the Swiss Society for Old Age Psychiatry
Ian Needham
Affiliation:
Ian Needham, Hochschule für Angewandte Wissenschaften, St. Gallen, Switzerland Research Group of the Swiss Society for Old Age Psychiatry
Brigitte Schupbach
Affiliation:
Brigitte Schüpbach, Universitätsklinik für Psychiatrie, Bern, Switzerland Research Group of the Swiss Society for Old Age Psychiatry
*
Correspondence should be addressed to: Armin von Gunten, Service Universitaire de Psychiatrie de l'Age Avancé (SUPAA), Département de Psychiatrie – CHUV, Rte du Mont, 1008 Prilly VD, Switzerland. Phone: +41 21 643 62 67; Fax: +41 21 643 62 38. Email: armin.von-gunten@chuv.ch.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Vocally disruptive behavior (VDB) in the elderly is a common condition, especially in people with dementia, but difficult to treat. It may occur in as many as 40% of nursing home residents. This study is a review of the existing literature on this condition.

Method: The literature review was conducted using PubMed (particularly Medline and the Cochrane database) and reference lists from relevant publications in English, French, and German.

Results: Most studies are small and no conclusive prevalence data are available. Many biological and psychosocial treatments have been advocated, but most studies are little more than anecdotal case reports. It is evident that VDB can have deleterious consequences on others and the patients themselves, although no studies specifically examine the range or the pervasiveness of VDB. Etiopathogenic research on VDB is still in its infancy.

Conclusions: Most aspects surrounding VDB are insufficiently understood. The heterogeneity and multiple contributive factors regarding VDB suggest quite convincingly that a panoply of different interventions tailored to the individual's needs will be required to overcome VDB and the suffering related to it.

Keywords

behavioral and psychological symptoms of dementiaagitationelderlydementiatreatment
Type
Review Article
Information
International Psychogeriatrics , Volume 20 , Issue 4 , August 2008 , pp. 653 - 672
Copyright
© International Psychogeriatric Association 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Allen, L. D. (1982). Reduction of disruptively loud voice volume using a “tok-back” device. Applied Research in Mental Retardation, 3, 67–80.CrossRefGoogle ScholarPubMed
Allen, R. S., Burgio, L. D., Fischer, S. E., Hardin, J. M. and Shuster, J. L. (2005). Behavioral characteristics of agitated nursing home residents with dementia at the end of life. The Gerontologist, 45, 661–666.CrossRefGoogle ScholarPubMed
Alzheimer, A. (1907). Über eine eigenartige Erkrankung der Hirnrinde. Allgemeine Zeitschrift für Psychiatrie und Psychisch-Gerichtliche Medizin, 64, 146–148.Google Scholar
Andrewes, D. (1989). Management of disruptive behaviour in the brain-damaged patient using selective reinforcement. Journal of Behavior Therapy and Experimental Psychiatry, 20, 261–264.CrossRefGoogle ScholarPubMed
Barton, S., Findlay, D. and Blake, R. A. (2005). The management of inappropriate vocalisation in dementia: a hierarchical approach. International Journal of Geriatric Psychiatry, 20, 1180–1186.CrossRefGoogle ScholarPubMed
Beach, S. R., Schulz, R., Williamson, G. M., Miller, L. S., Weiner, M. F. and Lance, C. E. (2005). Risk factors for potentially harmful informal caregiver behavior. Journal of the American Geriatrics Society, 53, 255–261.CrossRefGoogle ScholarPubMed
Beck, C. et al. (1998). Correlates of disruptive behavior in severely cognitively impaired nursing home residents. The Gerontologist, 2, 189–198.CrossRefGoogle Scholar
Buchanan, J. A. and Fisher, J. E. (2002). Functional assessment and noncontingent reinforcement in the treatment of disruptive vocalization in elderly dementia patients. Journal of Applied Behavior Analysis, 35, 99–103.CrossRefGoogle ScholarPubMed
Burgener, S. C., Jirovec, M., Murrel, L. and Barton, D. (1992). Caregiver and environmental variables related to difficult behaviors in institutionalized, demented elderly persons. Journal of Gerontology, 47, 242–249.CrossRefGoogle ScholarPubMed
Burgio, L. D., Flynn, W. and Martin, D. (1988). Disruptive vocalizations in institutionalized geriatric patients. The Gerontologist, 28, 369–371.Google Scholar
Burgio, L. D. et al. (1994). Studying disruptive vocalization and contextual factors in the nursing home using computer-assisted real-time observation. Journal of Gerontology, 49, 230–239.CrossRefGoogle ScholarPubMed
Burgio, L., Scilley, K., Hardin, M., Hsu, C. and Yancey, J. (1996). Environmental “white noise”: an intervention for verbally agitated nursing home residents. Journal of Gerontology: Psychological Sciences and Social Sciences, 51B, P364–P373.CrossRefGoogle Scholar
Burgio, L. D., Scilley, K., Hardin, J. M. and Hsu, C. (2001). Temporal patterns of disruptive vocalization in elderly nursing home residents. International Journal of Geriatric Psychiatry, 16, 378–386.CrossRefGoogle ScholarPubMed
Cariaga, J., Burgio, L. D., Flynn, W. and Martin, D. (1988). Disruptive vocalizations in institutionalized geriatric patients. The Gerontologist, 28, 264A.Google Scholar
Cariaga, J., Burgio, L., Flynn, W. and Martin, D. (1991). A controlled study of disruptive vocalizations among geriatric residents in nursing homes. Journal of the American Geriatrics Society, 39, 501–507.CrossRefGoogle ScholarPubMed
Carlyle, W., Killick, L. and Ancill, R. (1991). ECT: an effective treatment in the screaming demented patient. Journal of the American Geriatrics Society, 39, 637.CrossRefGoogle ScholarPubMed
Casby, J. A. and Holm, M. B. (1994). The effect of music on repetitive disruptive vocalizations of persons with dementia. American Journal of Occupational Therapy, 883–889.CrossRefGoogle Scholar
Christie, M. and Ferguson, G. (1988). Can't anyone stop that screaming? The Canadian Nurse, 84, 30–32.Google ScholarPubMed
Clavel, D. S. (1999). Vocalizations among cognitively impaired elders. What is your patient trying to tell you? Geriatric Nursing, 20, 90–93.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J. and Werner, P. (1994). Verbally disruptive behaviors in elderly persons: a review. Facts and research in gerontology. InVellas, B. J., Albaredo, J. L. and Garry, P. J. (eds.), Dementia and Cognitive Impairment (pp. 73–89), Paris: Serdi.Google Scholar
Cohen-Mansfield, J. and Werner, P. (1997)a. Typology in disruptive vocalizations in older persons suffering from dementia. International Journal of Geriatric Psychiatry, 12, 1079–1091.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J. and Werner, P. (1997)b. Management of verbally disruptive behaviors in nursing home residents. Journal of Gerontology: Biological Sciences and Medical Sciences, 6A, M369-377.Google Scholar
Cohen-Mansfield, J., Werner, P. and Marx, M. S. (1990). Screaming in nursing home residents. Journal of the American Geriatrics Society, 38, 785-792.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J., Marx, M. S., Lipson, S. and Werner, P. (1999). Predictors of mortality in nursing home residents. Journal of Clinical Epidemiology, 52, 273–280.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J., Werner, P., Hammerschmidt, K. and Newman, J. D. (2003). Acoustic properties of vocally disruptive behaviour in the nursing home. Gerontology, 49, 161–167.CrossRefGoogle Scholar
Deguchi, A. et al. (1999). Improving symptoms of senile dementia by night-time spa bathing. Archives of Gerontology and Geriatrics, 29, 267–273.CrossRefGoogle ScholarPubMed
Doyon, J., Lazure, H. and Lévesque, L. (1993). Les cris répétés. The Canadian Nurse, 89, 42–44.Google Scholar
Draper, B. et al. (2000). Case-controlled study of nursing home residents referred for treatment of vocally disruptive behavior. International Psychogeriatrics, 12, 333–344.CrossRefGoogle ScholarPubMed
Drinka, P. J. and Bobbe, M. (1990). Screaming in the nursing home. Journal of the American Geriatrics Society, 38, 1380.CrossRefGoogle ScholarPubMed
Dwyer, M. and Byrne, G. J. (2000). Disruptive vocalization and depression in older nursing home residents. International Psychogeriatrics, 12, 463–471.CrossRefGoogle ScholarPubMed
Frenchman, I. B. (2000). Risperdone, haloperidol, and olanzapine for the treatment of behavioral disturbances in nursing home patients: a retrospective analysis. Current Therapeutic Research, Clinical and Experimental, 61, 742–750.CrossRefGoogle Scholar
Friedman, R., Gryfe, C. I., Tal, D. T. and Freedman, M. (1992). The noisy elderly patient: prevalence, assessment, and response to the antidepressant doxepin. Journal of Geriatric Psychiatry and Neurology, 5, 187–191.CrossRefGoogle Scholar
Gareri, P. et al. (2004). Comparison of the efficacy of new and conventional antipsychotic drugs in the treatment of behavioral and psychological symptoms of dementia (BPSD). Archives of Gerontology and Geriatrics, Suppl. 9, 207–215.CrossRefGoogle Scholar
Goddaer, J. and Abraham, I. (1994). Effects of relaxing music on agitation during meals among nursing home residents with severe cognitive impairment. Archives of Psychiatric Nursing, 8, 150–158.CrossRefGoogle ScholarPubMed
Goldberg, R. J. and Goldberg, J. (1996). Antipsychotics for dementia-related behavioural disturbances in elderly institutionalized patients. Clinical Geriatrics, 4, 58–68.Google Scholar
Gould, S. L. and Hyer, L. A. (2004). Dementia and behavioral disturbance: does premorbid personality really matter? Psychological Reports, 95, 1072–1078.Google ScholarPubMed
Greenwald, B. S., Marin, D. B. and Silverman, S. M. (1986). Serotoninergic treatment of screaming and banging in dementia. The Lancet, 2, 1464–1465.CrossRefGoogle ScholarPubMed
Hall, K. A. and O'Connor, D. W. (2004). Correlates of aggressive behavior in dementia. International Psychogeriatrics, 16, 141–158.CrossRefGoogle ScholarPubMed
Hallberg, I. R., Luker, K., Norberg, A., Johnsson, K. and Eriksson, S. (1990). Staff interaction with vocally disruptive demented patients compared with demented controls. Aging, 2, 163–171.Google ScholarPubMed
Hantikainen, V., Isola, A. and Helenius, H. (1998). Störendes Verhalten älterer HeimbewohnerInnen und die Anwendung von Pflegemethoden: eine deskriptive Studie über Schweizer Pflegeheime. Pflege, 11, 78–88.Google Scholar
Holst, G., Hallberg, I. R. and Gustafson, L. (1997). The relationship of vocally disruptive behavior and previous personality in severely demented institutionalized patients. Archives of Psychiatric Nursing, 6, 147–154.CrossRefGoogle Scholar
Hussian, R. A. and Hill, S. D. (1980). Sterotyped behaviour in elderly patients with chronic organic mental disorder. Journal of Gerontology, 35, 689–691.CrossRefGoogle Scholar
Jeandel, C. (2004). Comment gérer la déambulation et les cris du patient atteint de démence. Soins, 685, 44–45.Google Scholar
Kim, K. Y., Bader, G. M. and Jones, E. (2000). Citalopram for verbal agitation in patients with dementia. Journal of Geriatric Psychiatry and Neurology, 13, 53–55.CrossRefGoogle ScholarPubMed
Kopala, L. C. and Honer, W. G. (1997). The use of risperidone in severely demented patients with persistent vocalizations. International Journal of Geriatric Psychiatry, 12, 73–77.3.0.CO;2-X>CrossRefGoogle ScholarPubMed
Koss, E. et al. (1997). Assessing patterns of agitation in Alzheimer's disease patients with the Cohen-Mansfield Agitation Inventory. Alzheimer Disease and Associated Disorders, 11 (Suppl. 2), S45–S50.CrossRefGoogle ScholarPubMed
Lindgren, C., Hallberg, I. R. and Norberg, A. (1992). Diagnostic reasoning in the care of a vocally disruptive severely demented patient: a case report. Scandinavian Journal of Caring Sciences, 6, 97–103.CrossRefGoogle ScholarPubMed
Low, L. F., Brodaty, H. and Draper, B. (2002). A study of premorbid personality and behavioural and psychological symptoms of dementia in nursing home residents. International Journal of Geriatric Psychiatry, 17, 779–783.CrossRefGoogle ScholarPubMed
Matheson, W. E., Mian, M., MacPherson, F. and Anthony, J. (1976). Control of screaming behavior using aversive conditioning and time-out. Journal of Psychiatric Nursing and Mental Health Services, 14, 27–28.Google ScholarPubMed
Matteau, E., Landreville, P., Laplante, L. and Laplante, C. (2003). Disruptive vocalizations: a means to communicate in dementia? American Journal of Alzheimer's Disease and Other Dementias, 18, 147–153.CrossRefGoogle ScholarPubMed
McMinn, B. and Draper, B. (2005). Vocally disruptive behaviour in dementia: development of an evidence based practice guideline. Aging and Mental Health, 9, 16–24.CrossRefGoogle ScholarPubMed
Meares, S. and Draper, B. (1999). Treatment of vocally disruptive bahaviour of multifactorial aetiology. International Journal of Geriatric Psychiatry, 14, 285–290.3.0.CO;2-2>CrossRefGoogle Scholar
Meins, W., Frey, A. and Thiesemann, R. (1998). Premorbid personality traits in Alzheimer's disease: do they predispose to noncognitive behavioral symptoms? International Psychogeriatrics, 10, 369–378.CrossRefGoogle ScholarPubMed
Morrison, R. S. and Siu, A. L. (2000). A comparison of pain and its treatment in advanced dementia and cognitively intact patients with hip fracture. Journal of Pain and Symptom Management, 19, 240–248.CrossRefGoogle ScholarPubMed
Nagaratnam, N., Lim, W. and Hutyn, S. (2001)a. Some problematic behaviors in Alzheimer's dementia. Archives of Gerontology and Geriatrics, 32, 57–65.CrossRefGoogle ScholarPubMed
Nagaratnam, N., Ting, A. and Jolley, D. (2001)b. Thalamic tumour presenting as frontal lobe dysfunction. International Journal of Clinical Practice, 55, 492–493.CrossRefGoogle ScholarPubMed
Nagaratnam, N., Bou-Haidar, P. and Leung, H. (2003)a. Confused and disturbed behavior in the elderly following silent frontal lobe infarction. American Journal of Alzheimer's Disease and Other Dementias, 18, 333–339.CrossRefGoogle ScholarPubMed
Nagaratnam, N., Patel, I. and Whelan, C. (2003)b. Screaming, shrieking and muttering: the noise-makers amongst dementia patients. Archives of Gerontology and Geriatrics, 36, 247–258.CrossRefGoogle ScholarPubMed
Nakamuro, T., Futamura, N., Murata, K., Suzumura, A. and Takayanagi, T. (1998). Screaming during sleep in patients with Parkinson disease. Rinsho Shinkeigaku, 38, 457–460 (abstract only).Google ScholarPubMed
Pasion, R. C. and Kirby, S. G. (1993). Trazodone for screaming. The Lancet, 341, 970.CrossRefGoogle ScholarPubMed
Pollock, B. G. et al. (1997). An open pilot study of citalopram for behavioral disturbances of dementia. Plasma levels and real-time observations. American Journal of Geriatric Psychiatry, 5, 70–78.CrossRefGoogle ScholarPubMed
Pomara, N., Volavka, J., Czobor, P., Hernando, R. and Sidtis, J. J. (2005). Screaming and physical aggression in nursing homes. American Journal of Geriatric Psychiatry, 13, 539–540.CrossRefGoogle ScholarPubMed
Proctor, R. et al. (1999). Behavioural management in nursing and residential homes: a randomised controlled trial. The Lancet, 354, 26–29.CrossRefGoogle Scholar
Ramadan, F. H., Naughton, B. J. and Bassanelli, A. G. (2000). Treatment of verbal agitation with a selective serotonin reuptake inhibitor. Journal of Geriatric Psychiatry and Neurology, 13, 56–59.CrossRefGoogle ScholarPubMed
Roccaforte, W. H., Wengel, S. P. and Burke, W. J. (2000). ECT for screaming in dementia. American Journal of Geriatric Psychiatry, 8, 177.CrossRefGoogle ScholarPubMed
Rogers, J., Haviland, S. and O'Brien, J. (1987). Management of disruptive vocal behaviors in a nursing home population. The Gerontologist, 27, 33A–34A.Google Scholar
Rosin, A. J. (1977). The physical and behavioral complex of dementia. Gerontology, 23, 37–46.CrossRefGoogle ScholarPubMed
Roth, D. L., Stevens, A. B., Burgio, L. D. and Burgio, K. L. (2002). Timed-event sequential analysis of agitation in nursing home residents during personal care interactions with nursing assistants. Journal of Gerontology: Psychological Sciences, 578, p461–p468.CrossRefGoogle Scholar
Ryan, D. P., Tainsh, S. M., Kolodny, V., Lendrum, B. L. and Fisher, R. H. (1988). Noise-making amongst the elderly in long-term care. The Gerontologist, 28, 369–371.CrossRefGoogle ScholarPubMed
Ryden, M. B. (1988). Aggressive behavior in persons with dementia who live in the community. Alzheimer Disease and Associated Disorders, 2, 342–355.CrossRefGoogle ScholarPubMed
Senanarong, V. et al. (2004). Agitation in Alzheimer's disease is a manifestation of frontal lobe dysfunction. Dementia and Geriatric Cognitive Disorders, 17, 14–20.CrossRefGoogle ScholarPubMed
Sink, K. M., Covinsky, K. E., Newcomer, R. and Yaffe, K. (2004). Ethnic differences in the prevalence and pattern of dementia-related behaviors. Journal of the American Geriatrics Society, 52, 1277–1283.CrossRefGoogle ScholarPubMed
Sloane, P. D. et al. (1997). Management of the patient with disruptive vocalization. The Gerontologist, 37, 675–682.Google ScholarPubMed
Sloane, P. D., Mitchell, C. M., Preisser, J. S., Phillips, C., Commander, C. and Burker, E. (1998). Environmental correlates of resident agitation in Alzheimer's disease special care units. Journal of the American Geriatrics Society, 46, 862–869.CrossRefGoogle ScholarPubMed
Sloane, P. D., Davidson, S., Knight, N., Tangen, C. and Mitchell, C. M. (1999). Severe disruptive vocalizers. Journal of the American Geriatrics Society, 47, 439–445.CrossRefGoogle ScholarPubMed
Spence, S. A. (1999). A memorable patient: the screaming man. BMJ, 319, 489.CrossRefGoogle Scholar
Swanwick, G. R. (1995). Nonpharmacological treatment of behavioral symptoms. InLawlor, B. A. (ed.), Behavioral Complications in Alzheimer's Disease (pp. 183–207), Washington DC: American Psychiatric Press.Google Scholar
Teri, L. et al. (1992). Management of behavior disturbance in Alzheimer disease: current knowledge and future directions. Alzheimer Disease and Associated Disorders, 6, 77–88.CrossRefGoogle ScholarPubMed
Vance, D. E., Burgio, L. D., Roth, D. L., Stevens, A. B., Fairchild, J. K. and Yurick, A. (2003). Predictors of agitation in nursing home residents. Journal of Gerontology: Psychological Sciences, 58B, P129–P137.CrossRefGoogle Scholar
Verma, S. D., Davidoff, D. A. and Kambhampati, K. K. (1998). Management of the agitated elderly patient in the nursing home: the role of the atypical antipsychotics. Journal of Clinical Psychiatry, 59, 50–55.Google ScholarPubMed
Werner, P., Cohen-Mansfield, J., Braun, J. and Marx, M. S. (1989). Physical restraints and agitation in nursing home residents. Journal of the American Geriatrics Society, 37, 1122–1126.CrossRefGoogle ScholarPubMed
Whall, A. L., Gillis, G. L., Yankou, D., Booth, D. E. and Beel-Bates, C. A. (1992). Disruptive behavior in elderly nursing home residents: a survey of nursing staff. Journal of Gerontological Nursing, 13–17.CrossRefGoogle Scholar
White, M. K., Kaas, M. J. and Richie, M. F. (1996). Vocally disruptive behavior. Journal of Gerontological Nursing, 22, 23–29.CrossRefGoogle ScholarPubMed
Zachow, K. M. (1984). Helen, can you hear me? Journal of Gerontological Nursing, 10, 18–22.CrossRefGoogle ScholarPubMed