Decreasing Aggressive, Agitated, or Disruptive Behavior: PARTICIPATION IN A BEHAVIOR MANAGEMENT UNIT

Abstract

A 32-bed Behavior Management Unit was opened in a long-term care facility to care for dementia patients who exhibit aggressive, agitated, or disruptive (AAD) behaviors. The purpose of the study was to evaluate the effectiveness of the Behavior Management Program (BMP) in decreasing such behaviors. The sample consisted of all patients (N = 32) who resided in the unit for at least 3 months. The Nursing Home Behavior Problem Scale (NHBPS) was used to collect data. Hypothesis 1, predicting participation in the BMP would decrease the total number of AAD behaviors was supported, with a significant decrease from the baseline to 6-month measurements. Hypothesis 2, predicting participation in the BMP would decrease the frequency of occurrence of specific AAD behaviors was supported, with 7 behaviors being significantly reduced by 6 months. Nurses in long-term care often treat patients with AAD behavior. Because staff members on general long-term care units and even in dementia units may not be experts in caring for patients with AAD behaviors, the implications of this study might be helpful. The interventions that were effective in reducing AAD behaviors included verbal distraction, time-outs, activity diversion, getting to know the patient well, and managing the environment.

Efficacy of integrated interventions combining psychiatric care and nursing home care for nursing home residents: a review of the literature

“…The two most important outcomes reported were a decrease in the levels of general psychiatric symptoms (especially depression and agitation or aggression) (Brodaty et al, 2003;DeYoung et al, 2002;Holm et al, 1999;Kunik et al, 1996;Opie et al, 2002;Proctor et al, 1999;Rovner et al, 1996;Wiener et al, 2001) and improvement in global functioning (cognitive and functional status) (Holm et al, 1999;Kunik et al, 1996;Wiener et al, 2001). One of the four randomized controlled trials, which examined these outcomes, found no significant difference between nursing home patients who received psychiatric services and a comparison group that received care as usual.…”

“…Three of the four remaining studies used only psychological and/or neuropsychological and psychiatric examinations (2001) Opie (2002) DeYoung (2002) Brodaty (2003) ( Opie et al, 2002;Proctor et al, 1999;Rovner et al, 1996). The other study (DeYoung et al, 2002) does not clearly describe the examinations performed. Wiener also performed a nursing assessment of each patient's activities in daily life, while Kunik, Holm and Wiener examined the global functioning of all patients.…”

“…Wiener also performed a nursing assessment of each patient's activities in daily life, while Kunik, Holm and Wiener examined the global functioning of all patients. All of the included studies used individualized treatment plans with integrated tailored psychosocial, nursing, medical and pharmacological interventions (Kunik et al, 1996;Rovner et al, 1996;Holm et al, 1999;Proctor et al, 1999;Wiener et al, 2001;Opie et al, 2002;DeYoung et al, 2002;Brodaty et al, 2003). Individual or group psychotherapy was offered in three studies (Kunik et al, 1996;Holm et al, 1999;Brodaty et al, 2003).…”

“…Problem behaviour was defined as violent behaviour or other disruptive behaviour, psychosis or depression (Holm et al, 1999;Kunik et al, 1996;Wiener et al, 2001). The inclusion criterion for the special care unit programme was a referral from a nursing home or a hospital for untreatable disruptive behaviour that otherwise made referral to a psychiatric hospital necessary (DeYoung et al, 2002). Two out of four randomized controlled studies carried out within the nursing home demanded a DSM-IV diagnosis of dementia and disruptive neuropsychiatric symptoms (psychosis, depression or agitation/aggression) observed several times each day (Brodaty et al, 2003;Opie et al, 2002).…”

“…Eight studies were identified as relevant for the purpose of this review: Kunik et al, 1996;Rovner et al, 1996;Holm et al, 1999;Proctor et al, 1999;Wiener et al, 2001;Opie et al, 2002;DeYoung et al, 2002;Brodaty et al, 2003 (Table 2). The selected studies consisted of one retrospective cohort study (3 level of evidence), three prospective case series (3 level of evidence) and four randomized controlled trials (2b level of evidence).…”