Characteristics of vocally disruptive behaviour in residents with dementia in specialist dementia care hospitals and possible interventions

Background In 2002 the New Zealand Ministry of Health estimated there were 38,000 people with dementia living in New Zealand. 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. Little is known about the nature and severity of this problem in the New Zealand private residential hospital setting. Study Aims The first aim of this study is to measure the prevalence and nature of vocally disruptive behaviour in two private New Zealand residential dementia care hospitals. The second aim is to trial the use of a visual cueing system to test whether it can reduce the VDB of one private hospital resident as a pilot for a potential larger study. Method Phase one has three parts; a semi-quantitative interview with care-givers about their experience of VDB including management techniques; a review of the recording of VDB in residents’ clinical notes over a 48 hour period and direct observation of VDB to analyse the incidence, content of and response to VDB. Phase Two uses an N=1 methodology in an intervention trial of a visual cueing system as an augmentative communication strategy to reduce the participant’s incidence of VDB. Baseline recordings of the participants VDB were taken followed by an intervention period. Results Phase One a. Semi-quantitative interviews with residential care workers. All the participants had experienced looking after residents with VDB and all reported finding VDB stressful. A range of techniques to manage residents with VDB was reported. b. Clinical Notes review There was a low rate of reporting VDB in the clinical notes. It is likely that the staff in dementia care hospitals accept that VDB occurs in these facilities and do not consider it worthy of being formally recorded. The two hospitals had different patterns, with Hospital One recording more VDB in the morning shifts compared to Hospital Two. Hospital Two had a peak in calling out recorded during the night shifts. c. Direct Observation of VDB. The incidence of VDB at the two hospitals had different temporal patterns and the content also differed. Hospital One had more purposive VDB and Hospital Two had more hallucination related VDB. In response to VDB a range of management strategies were observed; a high proportion of VDB was ignored. Phase Two Limited data was collected as the participants VDB largely resolved during the intervention stage. This was unrelated to the intervention; therefore no strong conclusions can be drawn. Conclusion VDB occurs frequently in some New Zealand dementia care hospitals. This challenging behaviour is highly variable and case specific. Care-givers would benefit from specific training to equip them 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