A Multi-Methods Observatonal Study Of Persistent Vocalizations In Nursing Home Residents With Advanced Dementia

Persistent vocalizations (PVs), otherwise known as disruptive vocalizations or problematic vocalizations, are commonly exhibited by nursing home residents (NH) with advanced dementia. Older adults exhibiting this behavioral symptom of dementia can have detrimental outcomes such as physical exhaustion. PVs also cause distress to others in the same environment including other residents, NH staff, and visitors. The purpose of this body of work was to describe PVs in persons with advanced dementia in relation to observational and physiological variables prior to, during and after an episode of PVs. The Need-driven Dementia-compromised Behavior model informed this work. A systematic review was completed to learn the state of the science on the phenomenon of NH residents with dementia and PVs. Field observations of nine NH residents with advanced dementia and PVs were conducted. This was followed by combining physiological measures (heart rate and respiration rate) and directed observations from video recordings and sound meter readings on three of the participants. The state of the science reveals that there is limited available knowledge on this phenomenon, particularly around non-pharmacological interventions that are effective at minimizing PVs. A conventional content analysis was completed on field notes from the directed observations and three themes emerged: Routine of Staying in Room was identified for participants considered “disruptive” to others; Caregivers Interactions as Triggers to PVs (providing care without communicating and personal care); and Depends on the Day. Analysis of video recordings and physiological data revealed that the three participants had high heart rates prior to, during and after a PV episode compared to baseline heart rates. This body of work represents the only known research to look at the combination of PV characteristics and physiological characteristics of the NH residents with dementia exhibiting PVs.