Identifying patterns of disruptive behavior in long-term care residents

OBJECTIVES: To determine the frequency, timing, and pattern of 45 operation alized disruptive behaviors (DB) in older people in long-term care units. DESIGN: Nursing staff collected prospective descriptive data over 21 consec utive shifts for each patient to document prevalence, frequency, and co-occ urrences of DBs, SETTING: All of the eight long-term care units and one acute/admission unit of a large Veterans Administration Medical Center (VAMC). Each 40-bed unit had patients with varying levels of cognitive impairment and skilled nursi ng needs. PARTICIPANTS: The sample consisted of 240 hospitalized VA patients with a m ean age of 72.8 (SD = 8.6) years and mean length of stay of 4.02 (SD = 8.6) years. Residents had dementia, a psychiatric diagnosis, or mixed dementia and psychiatric diagnoses. MEASUREMENTS: The Disruptive Behavior Scale (DBS), an instrument designed f or collecting patient-level data on 45 separate DBs. RESULTS: In a 24-hour period, the average frequency was 3.6 DBs per subject . We found that 41.2% of DB occurred during the day shift, 39.2% during the evening shift, and 19.6% during the night shift. In 32% of observed occurr ences, only one DB occurred within the hour. In the remaining 68% of observ ations, two or more DBs occurred within the same hour. We found two behavio rs, Does Not Follow Directions and Excessive Motor Activity, to occur with multiple behaviors in multiple categories. Several characteristic patterns were noted; e.g., physically aggressive behaviors rarely co-occurred with v erbal DBs. physically nonaggressive behaviors seemed to occur most frequent ly with other physically nonaggressive behaviors and, to a lesser extent, w ith verbal DBs. CONCLUSIONS: These findings lend support to the existence of patterns of DB s in long-term care patients, a useful step toward targeting interventions early in the behavioral sequence.