Efficacy of Psychosocial Treatments for Noisemaking in Severe Dementia

Abstract

Noisemaking is one of the most disturbing behavior disorders associated with dementia. Standard management practices, including pharmacological interventions, are not very successful in treating the behavior. Very little research has been carried out to evaluate innovative treatments or to determine the etiology of noisemaking. In this article, we report on a series of 12 case studies in which we tested the efficacy of some psychosocial interventions in reducing the frequency of noisemaking in long-term-care residents with severe dementia. Interventions were contingent reinforcement of quiet behavior and environmental stimulation tailored to individual preferences. Of the 12 patients recruited into the study, 2 died during the course of observations, 3 were not observed to be as noisy as reported by staff, and 3 showed a clear reduction in noise during the intervention period. Four patients did not show any overall reduction in noisemaking during psychosocial interventions. Future research could differentiate between types of interventions in successful cases and attempt to control further for the consistent application of interventions by long-term-care staff.

An individualized psychosocial approach for [ldquor]treatment resistant[rdquor] behavioral symptoms of dementia among aged care residents

“…Doyle et al, 1997;Rabinowitz et al, 2005;Sloane et al, 2004). Particularly concerning was the high occurrence of physically aggressive behaviors, with more than half (54.8%) of the sample reported to have hit or hurt themselves or others at least daily over the previous two weeks.…”

Les cris récurrents chez le patient atteint de démence

“…Elles sont malheureusement argumentées pour la plupart par des études de cas, avec les limites méthodologiques que cela implique, en particulier par rapport au principe de généralisa-tion. En outre, il s'avère souvent que l'effet de ces interventions ne dure seulement que le temps de celles-ci [36][37][38]. En ce qui concerne les interventions centrées sur le patient, après les indispensables corrections des déficits sensoriels éventuels, des approches comportementales ou psychocorporelles ont été essayées (bain thérapeutique, toucher thérapeutique apaisant, appelé aussi « toucher affectif », massage relaxant) [39][40][41][42][43].…”

“…En ce qui concerne les interventions centrées sur le patient, après les indispensables corrections des déficits sensoriels éventuels, des approches comportementales ou psychocorporelles ont été essayées (bain thérapeutique, toucher thérapeutique apaisant, appelé aussi « toucher affectif », massage relaxant) [39][40][41][42][43]. Certains ont utilisé des activités occupationnelles (pliage, tabliers avec des poches à boutons, feuilletage de revues ou de catalogues, musicothérapie, aromathérapie, pet-thérapie, apaisement multi-sensoriel de type Snoezelen, chants, promenades, participation aux animations, écoute d'enregistrements musicaux ou de voix humaines) [18,36,[44][45][46]. En outre, il convient pour le soignant de continuer à dialoguer avec le patient dément crieur car parfois, seul le son de la voix humaine permet un apaisement et une réassurance [17].…”

Descriptive functional analysis of behavioral excesses shown by adults with Down syndrome and dementia

“…Within the general older adult dementia literature, a number of interventions employing behavioral approaches, with or without functional analysis, are evident. Examples include interventions for deficits such as disorientation and lack of self care skills via stimulus control, backward chaining verbal and visual prompting procedures (McEvoy and Patterson, 1986), co-morbid depression treated via increase in 'pleasant' reinforcement (Teri et al, 1997), and behavioral excesses such as disruptive vocalisation via differential reinforcement and stimulus control procedures (Doyle et al, 1997). Studies employing a functional analytic methodology prior to intervention have focused on behaviors such as disruptive vocalisation (Burgio et al, 1996;Buchanan and Fisher, 2002), wandering (Heard and Watson, 1999), agitated behavior (Bakke et al, 1994;Teri et al, 1998;Moniz-Cook et al, 2001) and various unspecified behavioral excesses within a group design (Moniz-Cook et al, 1998).…”