Effects of Behavioral Interventions on Disruptive Behavior and Affect in Demented Nursing Home Residents
Open accessAbstract
BACKGROUND: Disruptive behaviors are prevalent in nursing home residents with dementia and often have negative consequences for the resident, caregiver, and others in the environment. Behavioral interventions might ameliorate them and have a positive effect on residents' mood (affect). OBJECTIVES: This study tested two interventions-an activities of daily living and a psychosocial activity intervention-and a combination of the two to determine their efficacy in reducing disruptive behaviors and improving affect in nursing home residents with dementia. METHODS: The study had three treatment groups (activities of daily living, psychosocial activity, and a combination) and two control groups (placebo and no intervention). Nursing assistants hired specifically for this study enacted the interventions under the direction of a master's prepared gerontological clinical nurse specialist. Nursing assistants employed at the nursing homes recorded the occurrence of disruptive behaviors. Raters analyzed videotapes filmed during the study to determine the interventions' influence on affect. RESULTS: Findings indicated significantly more positive affect but not reduced disruptive behaviors in treatment groups compared to control groups. CONCLUSIONS: The treatments did not specifically address the factors that may have been triggering disruptive behaviors. Interventions much more precisely designed than those employed in this study require development to quell disruptive behaviors. Nontargeted interventions might increase positive affect. Treatments that produce even a brief improvement in affect indicate improved quality of mental health as mandated by federal law.
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Agitation in dementia is associated with poor quality of life.
“Agitation in dementia is associated with poor quality of life, 3”
From Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials (2014) · cites this paper as [3]
The first ten minutes of ADL care are reliable representations of verbal and nonverbal behaviors in comparison to entire interactions and are standard intervals in staff-resident interactions in dementia care research.
“The first ten minutes of ADL care have been established as reliable representations of verbal (r =.80 – .93) and nonverbal (r = .61 – .92) behaviors in comparison to entire interactions and are standard intervals in staff-resident interactions in dementia care research. 15, 16”
From Elderspeak's influence on resistiveness to care: focus on behavioral events (2009) · cites this paper as [16]
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What affects pleasure in persons with advanced stage dementia?
Cohen‐Mansfield, J., Marx, M. S., Freedman, L. S., Murad, H., Thein, K., & Dakheel‐Ali, M. (2011) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2011.12.003 · Cited by 46 · see citing works
“The positive impact of engagement with stimuli or activities on the affect of nursing home residents with dementia has been reported (Beck et al., 2002; Engelman et al., 1999; Orsulic-Jeras et al., 2000; Bowlby-Sifton, 2001; Libin & Cohen-Mansfield, 2004; Cohen-Mansfield et al., 2007; Cohen-Mansfield et al., 2011; Kol…”
BackgroundLiu, W., Jao, Y., & Williams, K. N. (2017) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2017.03.004 · Cited by 46 · see citing works
“, 1998), and have been used in dementia care research(Beck et al., 2002).”
MethodInfluentialRestorative care nursing activities: pilot testing self-efficacy and outcome expectation measures
Resnick, B. M., & Simpson, M. (2003) · Geriatric Nursing · doi:10.1067/mgn.2003.26 · Cited by 46 · see citing works
Handbook of Pain and Palliative Care
Moore, R. J. (2012) · Springer eBooks · doi:10.1007/978-1-4419-1651-8 · Cited by 116 · see citing works
“Response to excessive environmental stress is agitation and decreased function (Beck et al. 2002 ) .”
BackgroundA systematic mapping review of Randomized Controlled Trials (RCTs) in care homes
Gordon, A. L., Logan, P., Jones, R. G., Forrester-Paton, C., Mamo, J. P., & Gladman, J. R. F. (2012) · BMC Geriatrics · doi:10.1186/1471-2318-12-31 · Cited by 41 · see citing works
“and included Activities of Daily Living (ADL)-targeted interventions [29,30], re-orientation [31], pet therapy”
BackgroundMohler, R. A., Guiteras, A. R., Renom, H., & Meyer, G. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009812.pub2 · Cited by 43 · see citing works
Jablonski, R. A., Reed, D., & Maas, M. L. (2005) · Journal of Gerontological Nursing · doi:10.3928/0098-9134-20050601-10 · Cited by 40 · see citing works
Overview of Alzheimer's disease.
Souder, E., & Beck, C. (2004) · The Nursing Clinics of North America · doi:10.1016/j.cnur.2004.02.010 · Cited by 50 · see citing works
“Beck et al [74] conducted a clinical trial of environmental and behavioral strategies to promote functional independence, a psychosocial activities intervention that involved 25 standardized modules, and an intervention that combined the two approaches in nursing homes.”
BackgroundSelf-citationThe Effectiveness of Function-Focused Care Interventions in Nursing Homes: A Systematic Review
Lee, S. J., Kim, M. S., Jung, Y. J., & Chang, S. O. (2018) · Journal of Nursing Research · doi:10.1097/jnr.0000000000000268 · Cited by 39 · see citing works
“Beck et al. (2002) carried out an assessment of residents’ interests, which resulted in FFC interventions that were significantly more interesting to the residents (p = .028).”
BackgroundMethodInfluentialWorkforce development to provide person-centered care
Austrom, M. G., Carvell, C. A., Alder, C. A., Gao, S., Boustani, M. A., & LaMantia, M. A. (2015) · Aging & Mental Health · doi:10.1080/13607863.2015.1119802 · Cited by 38 · see citing works
“Studies have reported that clinical care providers often lack the knowledge required to apply the principles of person-centered care to everyday practice (Beck et al., 2002; Coker, 1998; Tellis-Nayak, 2007).”
Rehabilitating Patients With Dementia Who Have Had a Hip Fracture
McGilton, K. S., Wells, J., Teare, G. F., Davis, A. M., Rochon, E. A., Calabrese, S., Naglie, G., & Boscart, V. (2007) · Topics in Geriatric Rehabilitation · doi:10.1097/01.tgr.0000270185.98402.a6 · Cited by 38 · see citing works
Williams, K. N., Perkhounkova, Y., Jao, Y., Bossen, A., Hein, M., Chung, S. J., Starykowicz, A., & Turk, M. (2017) · Western Journal of Nursing Research · doi:10.1177/0193945917697226 · Cited by 37 · see citing works
“93) in complete interactions (Caris-Verhallen, Kerkstra, van der Heijden, & Bensing, 1998) and used in dementia research (Beck et al., 2002).”
Agronin, M. (2009) · Current Psychiatry Reports · doi:10.1007/s11920-009-0005-1 · Cited by 32 · see citing works
“Even mild to moderately demented individuals have benefi ted from various forms of group therapy, including cognitive-behavioral therapy [25], validation therapy [26], and a skills-training group focused on activities of daily living [ 27 ].”
BackgroundViau‐Guay, A., Bellemare, M., Feillou, I., Trudel, L., Desrosiers, J., & Robitaille, M.-J. (2013) · Canadian Journal on Aging / La Revue canadienne du vieillissement · doi:10.1017/s0714980812000426 · Cited by 32 · see citing works
“For example, the prevalence of psychological and behavioral symptoms related to dementia among CHSLD residents is between 55 and 85 per cent (Beck et al., 2002 ).”
BackgroundA randomized trial of early psychiatric intervention in residential care: impact on health outcomes
Kotynia-English, R., McGowan, H., & Almeida, O. P. (2005) · International Psychogeriatrics · doi:10.1017/s1041610205001572 · Cited by 31 · see citing works
Collet, J., de Vugt, M. E., Verhey, F. R. J., & Schols, J. M. G. A. (2009) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2307 · Cited by 30 · see citing works
“Most of these studies, however, focus primarily on dementia patients (Allen-Burge et al., 1999; Ayalon et al., 2006; Beck et al., 2002; Bharani and Snowden, 2005; Cohen-Mansfield, 2001; Cohen-Mansfield et al., 2007; Landreville et al., 1998; Livingston et al., 2005; Ryu et al., 2005; Spira and…”
Managing Pain to Prevent Aggression in People With Dementia
Bradford, A. M., Shrestha, S., Snow, A. L., Stanley, M. A., WILSON, N. L., Hersch, G. I., & Kunik, M. E. (2012) · American Journal of Alzheimer s Disease & Other Dementias® · doi:10.1177/1533317512439795 · Cited by 28 · see citing works
“For example, studies of nursing-home residents with dementia have found that expressions of positive affect are significantly more frequent during scheduled activity than during other periods.(71,72) Behavioral activation also directly counteracts avoidance that can lead to reduced environmental reinforcement and seco…”
BackgroundLandreville, P., Bédard, A., Verreault, R., Desrosiers, J., Champoux, N., Monette, J., & Voyer, P. (2006) · International Psychogeriatrics · doi:10.1017/s1041610205002929 · Cited by 29 · see citing works
Sidani, S., Streiner, D. L., & LeClerc, C. (2011) · International Journal of Older People Nursing · doi:10.1111/j.1748-3743.2011.00273.x · Cited by 25 · see citing works
“Those who are agitated pose a threat to themselves and to other residents; are at risk for falls and injury; and often suffer the adverse physical and psychosocial (e.g. social isolation) effects of restraints used as an intervention to minimise agitation prior to morning care (Beck et al., 2002).”
BackgroundKunik, M. E., Stanley, M. A., Shrestha, S., Ramsey, D. J., Richey, S. A., Snow, L., Freshour, J. S., Evans, T. L., Newmark, M. E., Williams, S., et al. (2020) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2020.01.190 · Cited by 23 · see citing works
“The intervention is rooted in the Unmet Needs Model (36) and other currently accepted frameworks for understanding behavioral problems, such as the Antecedent-Behavior- Consequences approach, (37) which underscores the importance of the interaction of individuals and their environment.”
BackgroundGender differences in predictors of survival in elderly nursing‐home residents: a 3‐year follow up
Sund‐Levander, M., Grodzinsky, E., & Wahren, L. K. (2007) · Scandinavian Journal of Caring Sciences · doi:10.1111/j.1471-6712.2007.00431.x · Cited by 23 · see citing works
Reactions of Assisted Living Staff to Behavioral and Psychological Symptoms of Dementia
McKenzie, G. L., Teri, L. L., Pike, K. C., LaFazia, D. M., & van Leynseele, J. (2012) · Geriatric Nursing · doi:10.1016/j.gerinurse.2011.12.004 · Cited by 22 · see citing works
Evidence-Based Interventions for Nursing Home Residents with Dementia-Related Behavioral Symptoms
Bharani, N. L. S., & Snowden, M. B. (2005) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2005.09.004 · Cited by 22 · see citing works
“(continued on next page) 9 5 IN T E R V E N T IO N S F O R D E M E N T IA -R E L A T E D S Y M P T O M S 2002 [45] psychosocial vs combination; placebo control, no intervention control, 12 wk training sca an”
BackgroundState of Nursing Science: On the Edge
Heitkemper, M. M., & Bond, E. F. (2003) · Biological Research For Nursing · doi:10.1177/1099800402239725 · Cited by 21 · see citing works
Sidani, S., LeClerc, C., & Streiner, D. L. (2009) · International Journal of Older People Nursing · doi:10.1111/j.1748-3743.2008.00154.x · Cited by 19 · see citing works
“social isolation) effects of chemical restraint used as an intervention prior to morning care (Beck et al., 2002).”
BackgroundRandall, E. W., & Clissett, P. (2015) · International Journal of Older People Nursing · doi:10.1111/opn.12083 · Cited by 18 · see citing works
“These interventions measured the behaviours of the person with dementia using the Disruptive Behavioural Scale (Beck et al., 2002), the Cohen-Mansfield Agitation Inventory (Remington, 2002; Hawranik et al., 2008; Deudon et al., 2009; and Cooke et al., 2010), the Demanding Behaviour Assessment Scale (Edberg & Hallberg,…”
BackgroundMethodInfluentialTesting Tele‐Savvy: Protocol for a randomized controlled trial
Kovaleva, M. A., Bilsborough, E., Griffiths, P. C., Nocera, J. R., Higgins, M. K., Epps, F. R., Kilgore, K. M., Lindauer, A., Morhardt, D., Shah, R. C., et al. (2018) · Research in Nursing & Health · doi:10.1002/nur.21859 · Cited by 18 · see citing works
“expertise of several disciplines, including nursing (Algase, Beattie, Antonakos, Beel-Bates, & Yao, 2010; Beck et al., 2002; Kovach, Noonan, Schildt, & Wells, 2005); psychology (Burgio, Stevens, Guy, Roth, & Haley, 2003; Coon, Thompson, Steffen, Sorocco, & Gallagher-Thompson, 2003; Teri, Logsdon, Uomoto, & McCurry, 19…”
Geropsychiatric Nursing: The State of the Science
Kolanowski, A. M., & Piven, M. L. S. (2006) · Journal of the American Psychiatric Nurses Association · doi:10.1177/1078390306292158 · Cited by 15 · see citing works
“In a placebo-controlled trial, Beck et al. (2002) demonstrated that psychosocial activities improve positive affect but not BPSD. Kolanowski, Litaker, and Buettner (2005) found, however, that matching activities to functional ability and personality style led to improvements in both affect and…”
BackgroundMohler, R. A., Calo, S., Guiteras, A. R., Renom, H., & Meyer, G. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009812.pub3 · Cited by 16 · see citing works
Managing Problem Behaviors Associated with Dementia
Remington, R., Abdallah, L., Melillo, K. D., & Flanagan, J. M. (2006) · Rehabilitation Nursing · doi:10.1002/j.2048-7940.2006.tb00134.x · Cited by 16 · see citing works
Andrews, G. J. (2016) · Nursing Philosophy · doi:10.1111/nup.12137 · Cited by 15 · see citing works
“…affect being a responsive experiential state of cognitive feeling or emotion follows engagement, which can be more objectively measured as a specific reaction [arising in gerontological nursing in the context of interventions for clients with dementia (Beck et al., 2002; Schreiner et al., 2005)].”
BackgroundEffective nursing interventions in ADL care affecting independence and comfort – a systematic review
Cremer, S., Vluggen, S., Ginkel, J. M. D. M., Metzelthin, S., Zwakhalen, S. M. G., & Bleijlevens, M. H. C. (2023) · Geriatric Nursing · doi:10.1016/j.gerinurse.2023.04.015 · Cited by 17 · see citing works
A música como recurso no cuidado à criança hospitalizada: uma intervenção possível?
Ferreira, C. C. M., Remedi, P. P., & de Lima, R. A. G. (2006) · Revista Brasileira de Enfermagem · doi:10.1590/s0034-71672006000500018 · Cited by 14 · see citing works
Kobayashi, N., & Yamamoto, M. (2004) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2004.03.003 · Cited by 14 · see citing works
Lee, K. H., Lee, J. Y., Boltz, M. P., & McConnell, E. S. (2019) · Worldviews on Evidence-Based Nursing · doi:10.1111/wvn.12395 · Cited by 14 · see citing works
Staff Reports of Behavioral Expressions of Persons With Dementia in 250 Assisted Living Communities
Dobbs, D., Zimmerman, S. I., Carder, P., Beeber, A., & Palmertree, S. (2021) · The Gerontologist · doi:10.1093/geront/gnab059 · Cited by 13 · see citing works
Live Music Promotes Positive Behaviours in People with Alzheimer's Disease
Cox, E., Nowak, M. J., & Buettner, P. G. (2014) · British Journal of Occupational Therapy · doi:10.4276/030802214x14151078348477 · Cited by 13 · see citing works
“Similar behaviours have been noted in studies of background music and music therapy (Beck et al 2002, Brotons and Marti 2003, Brotons and Pickett-Cooper 1996), as have improvements in language and social skills (Brotons and Marti 2003).”
ResultKovach, C. R. (2011) · Springer eBooks · doi:10.1007/978-1-4419-1651-8_10 · Cited by 13 · see citing works
Benefits and Challenges of Electronic Surveillance in Nursing Home Research
Sifford, K. S., & Bharucha, A. J. (2009) · Research in Gerontological Nursing · doi:10.3928/19404921-20090706-01 · Cited by 13 · see citing works
Jordan, K., & Church, T. (2013) · Journal of Nursing Education · doi:10.3928/01484834-20130218-03 · Cited by 12 · see citing works
Pringle, D. M. (2003) · PubMed · Cited by 12 · see citing works
Measurement and evaluation of body temperature : Implications for clinical practice
Sund‐Levander, M. (2004) · DiVA (Linkoping University) · Cited by 12 · see citing works
Ready, R. E., Carvalho, J. O., Green, R. C., Gavett, B. E., & Stern, R. A. (2011) · International Psychogeriatrics · doi:10.1017/s104161021100041x · Cited by 11 · see citing works
Culture Change for Residents With Dementia
Volicer, L. (2008) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2008.04.014 · Cited by 11 · see citing works
“It is also not clear how their intervention differs from interventions used in other studies, such as Beck et al.3 That study attempted to meet residents’ psychosocial needs for territoriality, communication, autonomy, and self-esteem to promote their sense of safety and security using 3 types of strategies specific t…”
Grief Among Demented Elderly Individuals
Johansson, Å. K., & Grimby, A. (2012) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909112457009 · Cited by 9 · see citing works
“Treatments that produce even a brief improvement might indicate improved quality of mental health also to demented people.(25)”
BackgroundNon-Pharmacological Approaches to Reducing Negative Behavioral Symptoms
Wong, C. M., & Leland, N. E. (2016) · OTJR Occupational Therapy Journal of Research · doi:10.1177/1539449215627278 · Cited by 9 · see citing works
“Individuals who demonstrate negative behavioral symptoms are at a higher risk of self-inflicted pain and accidental falls and injuries (Beck et al., 2002).”
BackgroundResultInfluentialMadsø, K. G., Flo, E., Pachana, N. A., & Nordhus, I. H. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.742510 · Cited by 10 · see citing works
“…were skewed and not normally distributed (see Asplund et al., 1995; Magai et al., 1996, 2002; Perrin, 1997; Lawton et al., 1999; Judge et al., 2000; Beck et al., 2002; Kinney and Rentz, 2005; Wood, 2005; Phillips et al., 2010; Casey et al., 2014; Beerens et al., 2016; de Boer et al., 2016; Lokon…”
BackgroundInfluentialManagement of behavioural and psychological symptoms of dementia and acquired brain injury
Sadavoy, J., Lanctôt, K. L., & Deb, S. S. (2008) · Cambridge University Press eBooks · doi:10.1017/cbo9780511544392.012 · Cited by 9 · see citing works
Nonpharmacological Management of Agitated Behaviours Associated with Dementia
Forbes, D. A., Peacock, S., & Morgan, D. (2005) · Cited by 9 · see citing works
Evaluating non-pharmacological approaches to nursing home dementia care: A protocol
Leland, N. E., Shier, V., Piersol, C. V., Lekovitch, C. A., Martínez, J., Bae‐Shaaw, Y. H., Sood, N., Day, C. E., Cass, P., Como, D. H., et al. (2023) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2023.101161 · Cited by 8 · see citing works
“If untreated, these behavioral and psychological symptoms result in negative side effects (e.g., injuries to self or others, limited food intake, accidental falls) increasing the risk of hospitalization and death [4,5].”
Psychologische Interventionen bei demenziellen Erkrankungen
Fischer-Terworth, C., Probst, P., Glanzmann, P. G., & Knorr, C. C. (2009) · Zeitschrift für Psychiatrie Psychologie und Psychotherapie · doi:10.1024/1661-4747.57.3.195 · Cited by 8 · see citing works
Die deutsche Fassung der «Serial Trial Intervention» (STI-D)
Fischer, T., Kuhlmey, A., Sibbel, R., & Nordheim, J. (2008) · Zeitschrift für Gerontopsychologie & -psychiatrie · doi:10.1024/1011-6877.21.3.199 · Cited by 7 · see citing works
- Authors
- Beck, C. K., Vogelpohl, T. S., Rasin, J. H., Uriri, J. T., O???Sullivan, P., Walls, R., Phillips, R., & Baldwin, B.
- Affiliations
- National Institutes of Health (US)
- Stevenson University (US)
- ORCID
- Phillips, Regina
- Venue
- Nursing Research
- Published
- 2002-07
- Volume
- 51
- Issue
- 4
- Pages
- 219-228
- ISSN
- 0029-6562 (ISSN-L)
- OpenAlex
- W2040325460
- Cited by
- 143
- References
- 37
- Citations by year
- 2024: 2 · 2023: 3 · 2022: 2 · 2021: 2 · 2020: 3 · 2019: 4 · 2018: 6 · 2017: 4 · 2016: 8 · 2015: 4 · 2014: 11 · 2013: 7 · 2012: 9
- FWCI
- 5.98
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Nursing Research (publishedVersion)
- PubMed (publishedVersion)
- Maryland Shared Open Access Repository (USMAI Consortium) (submittedVersion)
- Digital Repository at the University of Maryland (University of Maryland College Park)
- Funders
- National Institutes of Health (5r01ag010321-05)
- National Institute on Aging (R01 AG10321)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- dementia, disruptive behavior, affect, nursing home residents, behavioral interventions, activities of daily living, nursing assistants, positive affect, long-term care
- MeSH terms
- Activities of Daily Living, Aged, Aged, 80 and over, Analysis of Variance, Behavior Therapy, Dementia, Female, Geriatric Nursing, Homes for the Aged, Humans, Interpersonal Relations, Male, Nursing Homes, Social Behavior Disorders, United States, Nursing Research
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