Vocally disruptive behaviour in severely demented patients in relation to institutional care provided

Sammanfattning: Thirty-seven patients identified as vocally disruptive and a control group, selected from 264 patients at psychogeriatric wards were studied. Tape-recordings of their vocal behaviour, ratings of their functional performance and symptoms related to dementia, observations of their behaviour, activities and interaction with caregivers were performed. Seventeen plus sixteen caregivers were interviewed to give their interpretation of the experience behind the behaviour and describe their own experience of it. The severely demented vocally disruptive patients were found to be significantly more physically dependant, disorientated at the ward and prone to confusional reactions but they had a more preserved speech performance than the controls. The vocal activity expressed such as helplessness, pain, fear and protest. Some were emotionally indifferent and a few expressed positive emotions. Caregivers interpreted the behaviour as an expression of anxiety related to such as abandonment, dissolution and loss of autonomy. They also expressed a strong wish to comfort the patients but felt unable to do so. The patients' daily life was characterized by idleness and solitude. Caring activities and interactions were dominated by physical procedures performed in a fragmentary and rapid way. Two hypotheses are generated. 1. Vocally disruptive behaviour develops influenced by sensory deprivation and the brain damage. 2. The care provided is influenced by caregivers experiencing anxiety in the patients as well as experiencing a conflict between the care they would like to provide and the care they actually provide. This evokes anxiety in them which elicits defence mechanisms leading to emotional withdrawal from the patients and task oriented care. The results are discussed in a nursing perspective based on existential thoughts, psychoanalytic and psychosocial theory.