Contexts and impacts of disruptive behavior in institutionalized elders

This study describes the development of the Disruptive Behavior Impact Asse ssment (DBIA) designed to measure three aspects of severity of 44 disruptiv e behaviors: (1) the resources used to address DBs (e.g, increased patient care time), (2) the physical impact of DBs (e.g. injury to the patient or o thers), and (3) the psychological impact of DBs on staff. Data were collect ed prospectively for 21 consecutive shifts on each of 240 institutionalized subjects diagnosed with cognitive impairment, psychiatric, and mixed diagn oses. The contexts and impacts of 894 episodes of disruptive behaviour are described. Although 25% of all disruptive behaviors required no interventio n, those receiving intervention required 24 minutes to manage the 'average' disruption, the majority of which was spent on direct care. Physical impac t included injuries to others (0.8%) and physical damage to the environment (0.9%). The average caregiver reported minimal emotional adverse affect fr om DBs.