Cover not available
Article published In:
Dementia-compromised language conflict and aggression
Edited by Boyd Davis
[Journal of Language Aggression and Conflict 4:1] 2016
► pp. 90–113

“Patience, please”

Vocally disruptive behaviours in dementia care

| University of Canterbury, NZ
A significant number of people with dementia show challenging behaviours; one of the most challenging is vocally disruptive behaviour (VDB). VDB may be difficult to manage in all settings but particularly in rest homes and private dementia care hospitals. In a 2011 study direct observation of VDB was used to analyse the incidence, content of and response to VDB in two private New Zealand residential dementia care hospitals. Examples of VDB from both hospitals are discussed to illustrate the nature of VDB, both purposive and non-purposive. The relationship of the antecedents and consequences to the VDB are highlighted. Possible interventions to reduce VDB are reviewed. This challenging behaviour is highly variable and case specific. Caregivers would benefit from specific training to equip themselves with a range of interventions to allow for the individual needs of residents and the changing nature of the behaviour. More studies that use direct observation and participatory action research would enhance the current understanding of VDB and how to effectively manage it.
Keywords: vocally disruptive behaviour, dementia, residential care
Published online: 11 August 2016
DOI logo
https://doi.org/10.1075/jlac.4.1.04wyl
References (43)
Algase, Donna L, Cornelia Beck, Ann Kolanowski, Ann L. Whall, Stanley Berent, Kathy Richards, and Elizabeth Beattie. 1996. “Need-driven Dementia Compromised Behaviour: An Alternative View of Disruptive Behaviour.” American Journal of Alzheimer’s Disease 1161: 10–19. DOI logoGoogle Scholar
Asp, Ellisa D., and Jessica de Villiers. 2010. When Language Breaks Down. Cambridge: Cambridge University Press. DOI logoGoogle Scholar
Allen-Burge, Rebecca, Alan B. Stevens, and Louis B. Burgio. 1999. “Effective Behavioural Interventions for Decreasing Dementia-related Challenging Behaviour in Nursing Homes.” International Journal of Geriatric Psychiatry 14 (3): 213–228. DOI logoGoogle Scholar
Babbage, Duncan R. 2005. “Noise in the Nursing Home: A Case Study of Relationship Change.” Clinical Psychologist 92 (2): 74–82. DOI logoGoogle Scholar
Bachman, David, and Peter Rabins. 2006. “Sundowning and Other Temporally Associated Agitation States in Dementia Patients.” Annual Reviews 571: 499–511. DOI logoGoogle Scholar
Bliswise, Donald L. 1994. “What is Sundowning?” Journal of the American Geriatrics Society 42 (9):1009-1011. DOI logoGoogle Scholar
Burgio, Louis D., Kay Scilley, J. Michael Hardin, Janine Janosky, Paula Bonino, and Sharon C. Slater. 1994. “Studying Disruptive Vocalisation and Contextual Factors in the Nursing Home Using Computer-Assisted Real-Time Observation.” Journal of Gerontology 495 (5): 230–239. DOI logoGoogle Scholar
Algase, Donna L, Cornelia Beck, Ann Kolanowski, Ann L. Whall, Stanley Berent, Kathy Richards, and Elizabeth Beattie. 1996. “Need-driven Dementia Compromised Behaviour: An Alternative View of Disruptive Behaviour.” American Journal of Alzheimer’s Disease 1161: 10–19. DOI logoGoogle Scholar
Asp, Ellisa D., and Jessica de Villiers. 2010. When Language Breaks Down. Cambridge: Cambridge University Press. DOI logoGoogle Scholar
Allen-Burge, Rebecca, Alan B. Stevens, and Louis B. Burgio. 1999. “Effective Behavioural Interventions for Decreasing Dementia-related Challenging Behaviour in Nursing Homes.” International Journal of Geriatric Psychiatry 14 (3): 213–228. DOI logoGoogle Scholar
Babbage, Duncan R. 2005. “Noise in the Nursing Home: A Case Study of Relationship Change.” Clinical Psychologist 92 (2): 74–82. DOI logoGoogle Scholar
Bachman, David, and Peter Rabins. 2006. “Sundowning and Other Temporally Associated Agitation States in Dementia Patients.” Annual Reviews 571: 499–511. DOI logoGoogle Scholar
Bliswise, Donald L. 1994. “What is Sundowning?” Journal of the American Geriatrics Society 42 (9):1009–1011. DOI logoGoogle Scholar
Burgio, Louis D., Kay Scilley, J. Michael Hardin, Janine Janosky, Paula Bonino, and Sharon C. Slater. 1994. “Studying Disruptive Vocalisation and Contextual Factors in the Nursing Home Using Computer-Assisted Real-Time Observation.” Journal of Gerontology 495 (5): 230–239. DOI logoGoogle Scholar
Burns, Alistair, John O’Brien, and David Ames (eds). 2005. Dementia. 3rd ed. London: Hodder Arnold. DOI logoGoogle Scholar
Cariaga, José, Louis Burgio, William Flynn, and David Martin. (1999) “A Controlled Study of Disruptive Vocalizations among Geriatric Residents in Nursing Homes.” Journal of the American Geriatrics Society 39 (5): 501–507. DOI logoGoogle Scholar
Cohen-Mansfield, Jiska, and Perla Werner. 1997a. “Management of Verbally Disruptive Behaviours in Nursing Home Residents.” The Journal of Gerontology, 52A (6): 369–377.Google Scholar
. 1997b. “Typology of Disruptive Vocalizations in Older Persons Suffering from Dementia.” International Journal of Geriatric Psychiatry 12 (11): 1079–91. DOI logoGoogle Scholar
Declercq, Tom, Mirko Petrovic, Majda Azermai, R. Vander Stichelle, An De Sutter A., Meikle L. van Driel, and Thierry Christiaens. 2013 “Withdrawal versus Continuation of Chronic Antipsychotic Drugs for Behavioural and Psychological Symptoms in Older People with Dementia.” Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD007726. DOI logoGoogle Scholar
Desai Abhilash K., and George T. Grossberg. 2001. “Recognition and Management of Behavioural Disturbances in Dementia.” The Primary Care Companion to the Journal of Clinical Psychiatry 3 (3): 93–109. DOI logoGoogle Scholar
Draper, Brian, Jane Turner, Bryan McMinn, Peter Gonski, P. Helen McIntosh, Linda Latham, Deborah Draper, Georgina Luscombe, and Susanne Meares. 2003. “Outcome of Treatment of Vocally Disruptive Behaviour in Nursing Home Residents.” Australasian Journal on Aging 222 (2): 80–84. DOI logoGoogle Scholar
Fraser, Tony, and Murray Tilyard, M. 2008. Antipsychotics for Dementia Best Practice Guide. Dunedin: New Zealand Best Practice Advocacy Centre.Google Scholar
Gellad, Walid F., Jerry L. Grenard, and Zachary A. Marcum. 2011. “A Systematic Review to Barriers to Medication Adherence in the Elderly: Looking Beyond Cost and Regimen Complexity.” American Journal of Geriatric Pharmacotherapy 9 (1): 11–23. DOI logoGoogle Scholar
Hallberg, Ingalill R., Astrid Norberg, and Sture Eriksson. 1990. “A Comparison between the Care of Vocally Disruptive Patients and that of Other Residents at Psychogeriatric Wards.” Journal of Advanced Nursing 15 (4): 410–416. DOI logoGoogle Scholar
Hyden, Lars-Christa. 2011. “Non-Verbal Vocalizations, Dementia and Social Interaction.” Communication and Medicine 8 (2): 135–144. DOI logoGoogle Scholar
Isaksson, Ulf, Ulla H. Graneheim, Sture Åström, and Stig Karlsson. 2011. “Physically Violent Behaviour in Dementia Care: Characteristics of Residents and Management of Violent Situations.” Aging & mental health 15 (5): 573–579. DOI logoGoogle Scholar
Klaffke, Stefanie, and Juergan Staedt. 2006. “Sundowing and Circadian Rhythm Disorders in Dementia.” Acta neurologica belgica 106 (4): 168–175.Google Scholar
Love, Karen, and Jackie Pinkowitz. (2013). “Person-Centred Care for People with Dementia: A Theoretical and Conceptual Framework.” Journal of the American Society on Aging 31: 23–29.Google Scholar
Magri, Caroline Jane, Peter Ferry, and Stephen Abela. 2007. “A Review of the Aetiology and Management of Vocal Behaviour in Dementia.” Malta Medical Journal 19 (3): 30–35.Google Scholar
Matteau, Evelyne, Philippe Landreville, Louis Laplante, and Christian Laplante. 2003. “Disruptive Vocalizations: A Means to Communicate in Dementia?” American Journal of Alzheimer’s Disease and Other Dementias 18 (3): 147–153. DOI logoGoogle Scholar
McMinn, Bryan, and Brian Draper. 2005. “Vocally Disruptive Behaviour in Dementia: Development of an Evidence Based Practice Guideline.” Aging & Mental Health 9 (1): 16–24. DOI logoGoogle Scholar
New Zealand Ministry of Health. 2013. “New Zealand Framework for Dementia Care.” Wellington: New Zealand Ministry of Health.Google Scholar
Nagaratnam, Nages, Ilesh Patel, and Clair Whelan. 2003. “Screaming, Shrieking and Muttering: The Noise-makers amongst Dementia Patients.” Archives of Gerontology and Geriatrics 36 (3): 247–258. DOI logoGoogle Scholar
Neal M., and Barton Wright P. 2003. “Validation Therapy for Dementia.” Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD001394. DOI logoGoogle Scholar
Nelson, Jean. 1995. “The Influence of Environmental Factors in Incidents of Disruptive Behaviour.” Journal of Gerontological Nursing 21 (5): 19–24 DOI logoGoogle Scholar
Opie, Janet, Richard Rosewarne, and Daniel W. O’Connor. 1999. “The Efficacy of Psychosocial Approaches to Behaviour Disorders in Dementia: A Systematic Literature Review.” Australian and New Zealand Journal of Psychiatry 33 (6): 789–799. DOI logoGoogle Scholar
Palmer, Catherine V., Sheneekra W., John Durrant, Michelle Bourgeois, and Michelle Rossi. 1999. “Reduction in Caregiver-identified Problem Behaviours in Patients with Alzheimer Disease Post Hearing-aid Fitting.” Journal of Speech, Language and Hearing Research 421: 312–328. DOI logoGoogle Scholar
Ryan, D.P., S.M. Tainsh, V. Kolodny, B.L. Lendrum, and R.H. Fisher. 1988. “Noise-Making amongst the Elderly in Long Term Care.” The Gerontologist 28 (3): 369–371. DOI logoGoogle Scholar
Schiffer, Randolph, Robert M. Herndon, and Richard A. Rudick. 1985. “Treatment of Pathologic Laughing and Weeping with Amitriptyline.” New England Journal of Medicine 3121: 1480–1482. DOI logoGoogle Scholar
Scott, Ann, Assumpta Ryan, Ian James, and Elizabeth A. Mitchell E. 2011. “Perceptions and Implications of Violence from Care Home Residents with Dementia: A Review and Commentary.” International Journal of Older People Nursing. Special Issue: Dementia and Delirium 6 (2): 110–122. DOI logoGoogle Scholar
Sloane, Philip. D., Susan Davidson, Kathleen Buckwalter, Anthony Lindsey, Susan Ayers, Vonda Lenker, and Louis D. Burgio. 1997. “Management of the Patient with Disruptive Vocalisation.” The Gerontologist 37 (5): 675–682. DOI logoGoogle Scholar
von Gunten, Armin, Abdel-Messiah Alnawaqil, Christoph Abderhalde, Ian Needham, and Brigette Schupbach. 2008. ‘‘Vocally Disruptive Behaviour in the Elderly: A Systematic Review.” International Psychogeriatrics 2041:1–20Google Scholar
Wyles, Christine. 2011. “Characteristics of Vocally Disruptive Behaviour in Residents with Dementia in Specialist Dementia Care Hospitals and Possible Interventions.” M.A. thesis, University of Otago. Retrieved from [URL]. Permanent link to OUR Archive version: [URL]