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DISCLAIMER ...
There is no hard and fast answer to addressing a problem behaviour.
The following information is provided as a tool to help the Caregiver find the solution that works for situation they are faced with.

Problem Behaviours - Verbal Noises / Screaming

| Possible Causes | Coping Strategies | Other Considerations | Additional Information

Symptoms of dementia can cause a flood of emotions and physical reactions, which can manifest in behavioral problems. Understanding the cause and effect can help family and professional caregivers cope better with situations that may arise. More than half of patients with Alzheimer’s Disease exhibit some type of "agitation" behavior over the course of a year.

Behavior management experts define "agitation behavior" as "inappropriate verbal or motor activity."

Non-aggressive Verbal Behavior - For Example, Incoherent babbling, screaming or repetitive questions is frustrating to the caregiver and family members.

Aggressive Verbal Behavior - For Example, Cursing and abusive language can be shocking when your loved one was previously upright and proper.

Some caregivers suggest that agitation behavior and aggression tend to occur more if the person was calmer when they were well: that the disease causes them to act opposite from their original behavior. Researchers have not backed that assertion up. However, researchers do say that men are twice as likely to exhibit aggressive behavior, especially in the middle to late stages of the disease, or if they have major depression. The degradation of different parts of the brain causes aberrant behavior. Other conditions, such as pain, can also lead to it.

All types of behavior are forms of communication. It is possible the sufferer is trying to tell you something even though the disease has robbed them of other ways (i.e., talking) of telling you. Perhaps your loved one is depressed or in pain and does not know how to express it in words. Some experts believe that agitation behavior is "the inability the deal with stress."

Possible Causes

Physiological or Medical Causes

  • Hunger
  • Incontinence
  • Fatigue
  • Needs help changing position or getting comfortable.
  • Vision or hearing loss that causes misperception of the environment.
  • Impaired ability to speak or be understood.
  • Acute medical problems that result in feeling ill or in pain or discomfort, such as wounds, abdominal pain and cramp, flu, colds, headache, pneumonia, urinary tract infections, congestive heart failure

Environmental Causes

  • Too much noise
  • Over stimulation of sensory reception - too much happening
  • Use of physical restraint
  • Feeling boxed in Upset by behaviour or tension of others in environment (aggression, screaming, verbal abuse causing a feeling of fear, threat)

Other Causes

  • Procedures which are uncomfortable or not understood - being categorized, spoken in third person
  • Bathing - person may feel cold or exposed
  • Dressing - person may feel cold or exposed
  • Touch/turning/repositioning - uncomfortable or not understood
  • Fear / Anxiety
  • Need for attention
  • Feeling threatened
  • Frustration
  • Depression
  • Boredom / Lack of stimulation

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Coping Strategies

  • Institute regular toileting schedule to minimize incontinence.
    • Change promptly after incontinent episodes.
  • Try rest periods to minimize fatigue.
  • Make sure there are frequent position changes if person is bedridden or restrained in chair (at least every 1-2 hours).
  • Maximize sensory input. (Check to see whether hearing aid and eyeglasses are in plice and working properly.)
  • Lower stress
  • Create a relaxing environment:
    • Minimize noise.
    • Avoid over stimulation/sensory overload.
    • Avoid use of restraints.
    • Play soft, soothing music.
  • Use relaxation strategies to minimize fear, threat, and anxiety.
    • For example:
    • Try massage/therapeutic touch,
    • stroking person's head, arms, and hands.
    • Try placing your arms around the person and gently rocking back and forth.
    • Talk in a soothing voice.
    • Play soft, soothing music or soothing sounds such as tape of rainfall, waves breaking on shore, etc

Try these communication techniques:

  • Approach person with soothing voice ... Call person by his/her name and identify yourself.
  • Explain/prepare person for what is to be done using simple, clear, short sentences ... Break task into short steps briefly explaining each one.
  • Think of other ways for the person to communicate, such as using a bell ... This can enhance the person's sense of security by feeling that he/she is able to communicate needs to caregiver

For staff in long term care settings:

  • Use consistent routines for activities such as bathing, meals, getting ready for bed ... Keep to the same schedule each day.
  • Identify staff who work well with certain individuals ... Consistency in staffing is important in helping staff to establish a rapport and sense of trust with the individuals they are caring for.
  • Plan time to socialize with the person for a few minutes in addition to assisting with activities of daily living.
    • Encourage participation in meaningful activities to minimize boredom and frustration.
    • Activities and tasks need to be carefully adapted to each person's skill level.
  • Softly read to person.
  • Medication should be used only as A LAST RESORT when other interventions have failed and when the vocal behavior is very stressful to the caregivers and/or other residents.
    • The general indication for medication use is for those persons who scream at night and for whom other strategies have proved ineffective.
    • ANY medications have side effects and need to be monitored very carefully

Other Considerations

  • Vocal behaviors are most commonly seen in the later stages of progressive dementia, i.e., those individuals with moderate to severe cognitive impairment.
    • Many people who shout or cry out are physically immobile - wheelchair or bed-bound.
  • The underlying problem is the person's inability to communicate his/her needs, wishes, thoughts, etc.

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Additional Information

Beck, C. and P. Heacock. Nursing Interventions For Patients With Alzheimer's Disease. Nursing Clinics of North Arnenca, 23 (1), 1988.

Bernier, S. and N. Small. Disruptive Behaviors. Journal of Gerontological Nursing, 14 (2), February 1988.

Briun, K. and C. Rose. Geriatric Patient Outcome and Costs in Three Settings: Nursing Home, Foster Family and Own Home. Journal of American Geriatrics Society, 35, 1987.

Burgio, et. al. Behavior Problems In An Urban Nursing Home. Journal of Gerontological Nursing, 14 (1), 1988.

Butler, R., et. al. Neuroleptics and Behavior: A Comparative Study. Journal of Gerontological Nursing, 13(6), 1987.

Cohen-Mansfield, J. Agitated Behaviors In The Elderly: Preliminary Results In The Cognitively Deteriorated. Journal of American Geriatrics Society, 34 (10), 1986.

Cohen-Mansfield, J. and N. Billig. Agitated Behaviors In The Elderly: A Conceptual Review. Journal of Amencan Geriatrics Society, 34 (10), 1986.

Hall, G. and K. Buckwalter. Progressively Lowered Stress Threshold: A Conceptual Model For Care of Adults With Alzheimer's Disease. Arc/lives of Psychiatric Nursing, 1(6), 1987.

Hall, G. H. Alterations in Thought Process. Journal of Gerontological Nursing, 14 (3), 1988.

Hall, G., M. Kirschting, and S. Todd. Sheltered Freedom: The Creation of a Special Care Alzheimer's Unit in an ICF. Geriatric Nursing, 7 (3), 1986.

Maas, M. Management of Patient With Alzheimer's Disease in Long-Term Care Facilities. The Nursing Clinics of North America, 23 (1), 1988.

Rabins, P. Establishing Alzheimer's Disease Units In Nursing Homes: Pros and Cons. Hospital and Community Psychiatry, 36, 1986.

Roberts, B. and D. Algase. Victims of Alzheimer's Disease and The Environment. Nursing Clinics of North America, 23 (1), 1988.

Struble, L. and L. Silverstein. Agitated Behaviors in Confused Elderly Patients. Journal of Gerontological Nursing, 13 (11), 1987.

Wolanin, M. and L. Phillips. Confusion: Prevention and Care. St. Louis; C. V. Mosby Company, 1981.

 

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