Studying Disruptive Vocalization and Contextual Factors in the Nursing Home Using Computer-Assisted Real-Time Observation

Abstract

Disruptive vocalization (DV) is both a prevalent and disturbing problem in nursing homes. We developed a computer-assisted data collection system for real-time observation and recording of DV and various environmental contextual factors. Both frequency and duration of DV were recorded for 11 residents along with their location in the nursing home, their activity, environmental sound, the social environment, and whether or not the resident was physically restrained. The actual time of all events was also recorded. Measures of cognitive and ADL status were administered. The average occurrence of DV was 22 per hour and the average duration per occurrence was 26 seconds. The results show a significant upward linear trend in the occurrence of DV across the day. This is consistent with the "sundowning" hypothesis. A Cox Proportional Hazards Regression model indicates that another person present in the setting (p = .004) and resident presence at the nursing home hairdresser (p = .07) were associated with shorter duration episodes of DV. Correlational analyses indicate that both higher frequency and longer duration DV are related to greater cognitive impairment, and higher frequency DV is related to greater ADL impairment. We conclude that this computer-assisted real-time observational system is a useful and promising tool for studying disruptive behavior in its environmental context.

Effective behavioral interventions for decreasing dementia-related challenging behavior in nursing homes

“…The investigators hypothesized that`white noise' from the hair-dryer was responsible for the low rate of DV, and, thus, the implementation of the intervention. Burgio and colleagues (Burgio et al, 1996b) piloted the use of`gentle ocean' and`mountain stream' audiotapes played through headphones to decrease the frequency of DV among residents displaying a clinically signi®cant baseline rate of DV. A`functional analysis' phase provided data regarding individual dierences in resident refusal of the headphones and which of the two audiotapes were most eective.…”

“…In contrast to the focus on person±environment relationships in the interventions developed by Burgio and colleagues (Burgio et al, , 1996b, the idea behind simulated presence therapy (SPT) is that a`signi®cant other's'`presence' may be simulated in a resident's environment via audiotapes of that signi®cant individual recounting cherished memories (Woods and Ashley, 1995). This intervention, similar to Butler's (1961) life review, is intended to decrease agitation and increase social interaction.…”

“…Professional caregivers also experience a caregiver burden that contributes to job stress and turnover (Burgio et al, 1988). In US nursing homes, the prevalence of behavior problems ranges between 64% and 83% Zimmer et al, 1984).…”

“…Following the behavioral environmental model, behavior problems may be precipitated by internal or external stimuli, their expression may vary diurnally (Cohen-Mans®eld and Werner, 1994), and dierent problem behaviors may manifest at dierent points within the disease process (Bourgeois, 1991;Jackson et al, 1997). Notably, behavioral excesses such as disruptive vocalization may re¯ect a frustrated attempt on the part of the demented individual to communicate with the caregivers in his or her environment (Burgio et al, 1996b;Cohen-Mans®eld and Werner, 1998;Doyle et al, 1997).…”

Electrodermal activity: Explorations in the psychophysiology of engagement with social robots in dementia

“…People with dementia living in institutionalized contexts spend most of their time inactive [3]. However, several studies have demonstrated the importance of participation in activities to improve quality of life (QoL) and wellbeing in dementia [4][5] [6] [7] [8].…”