Staff interaction with vocally disruptive demented patients compared with demented controls

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.

Mood and general behavior of patients with severe dementia during one year of supervised, individualized planned care and systematic clinical supervision. Comparison with a similar control group

The aim of this study was to evaluate the effects of one year of systematic clinical supervision, and supervised individually planned care on the mood and general behavior of patients with dementia in relation to their cognitive function and level of confusion. The intervention was carried out in a ward devoted to the care of patients with severe dementia (EW), with a similar ward (CW) where no changes were made serving as a control. Each ward housed 11 patients, of whom 7 patients in each ward survived throughout the study time. Assessment of the patients' mood, general behavior, cognitive functions (MMSE), orientation and confusion (OBS) was made at baseline, and after 6 and 12 months of intervention. Significant deteriorations for the patients in CW were seen during the study period as regards the factor strength, functional performance and orientation in the ward, and speech performance and psychomotor slowing. For the patients in the EW, deterioration was seen only in the factor accessibility, and improvement was seen in the factor sensitivity and euphoria. The differences indicated that the development in the two wards went in opposite directions to the benefit of the patients in the EW. Because of the small sample size, the findings are more the result of a pilot trial, rather than generalizable. The intervention, however, seemed to have a positive effect on the secondary symptoms of the disease.

'Talk to me' Patient Communication in a Long-Term Care Facility

1. Staff are important facilitators for communication among elderly patients, who often are alone and bored for long periods. 2. Staff serve as an essential link between the patients and the outside world, and serve as a conduit for initiating contact between residents. 3. Environment--including the selection of roommates, the proximity of residents, and the volume of radios and televisions--may greatly alter residents' ability to communicate.

Care of demented patients with severe communication problems

Two time-studies and an interview study were carried out at a geriatric clinic. The aim was to elucidate how much time caregivers use for direct patient care in their contact with severely demented patients compared with non-demented patients as well as how they experience the care of demented patients in a task assignment care system. The analysis showed that more time was used to help non-demented patients than demented patients with the same ADL-performance. Five types of patient reactions to communicative attempts made by the caregivers were described: the patient seems to enjoy contact, he avoids contact, contact leads to aggression, he reacts only sporadically to contact and he does not show any reactions to it. The caregivers described negative reactions to demented patients with communication problems. Communication problems seem to be a threat to caregivers' commitment.