Vocally disruptive behaviors management in older people with dementia

Although shouting is a common psycho-behavioral symptom in geriatric institutions, the question of its assessment and treatment remains seldom studied and has rarely been the subject of specific recommendations. The combination of the focus group method and brainstorming has emerged as a methodology both relevant and feasible in geriatric facility to identify the coping strategies used by professionals and generalize guidelines for clinical observation and vocally disruptive behaviors management (shouting). The standardized gathering of professional experiences in nursing homes and their analysis with reference to results of the literature enabled the development of an analytical and clinical decision making diagram that can be an operational tool to cope with the occurrence of shouting in older people with dementia. Five types of triggers/aggravating shoutings emerged: 1) physical or moral pain and emotional reactions, 2) presence of sensory loss, 3) social isolation, under-stimulation or hyper sensitivity to stimulation and care, 4) reminiscences and 5) re-emergence of painful memories and loss of language skills. These factors have been associated with five methods of intervention : 1) pharmacological treatments, 2) animations, such as listening to music, physical activity and workshops using therapeutic mediation, 3) family or animal support and use of interventions to provide relaxation or stimulation, 4) interventions to deal with sensory deficits and 5) interventions modifying the environment.