Affective Responses to Behavioral Interventions

Until recently, caregivers viewed problematic behaviors in nursing home residents with dementia as disruptive and sought to quell them through physical and chemical restraints. Recent behavioral intervention studies have reported efficacy of behavioral interventions as a reduction in problematic behaviors, an outcome that addresses the needs of the onlooker but not necessarily those of the person displaying the behaviors. In recently completed studies of behavioral interventions to promote dressing independence and manage problematic behaviors in elderly nursing home residents with dementia, we noticed a serendipitous change in participants' demeanor or affective state. Intervention studies generally report outcomes as changes in the target behavior, yet behavioral interventions can have a major impact on a resident's affective state. Therefore, affect may provide another means of measuring outcomes for persons with dementia. We are testing this theory in a third study by evaluating participants' affective behaviors from videotapes filmed during the problematic behaviors study. In this article, we discuss literature supporting the use of affect as an outcomes measure in intervention studies and then describe our studies and the development of an instrument for measuring affect.