Extinction of care-induced vocalizations by a desensitization routine on a palliative care unit

Vocalizations during care occur frequently in patients with dementia, and are not uncommon in the palliative setting. Underlying trigger factors may include pain during movement, fear of being turned, startle reflex, attempts at verbal communication, environmental factors such as cold water, and other possible etiologies. A case of a 92 year old female who screamed and called out during bathing is presented. This patient with comorbid dementia and brain lesions did not respond to pre-event pain medication, and became somnolent due to opioid administration for presumed incident pain. A non-pharmacological approach, with a patient-centered focus rather than task orientation, succeeded in extinguishing the vocalizations after a period of six weeks.