title: Severe disruptive vocalizers.
abstract: OBJECTIVE
  To describe the most severe disruptive vocalizers in nursing facilities, in regard to their clinical and behavioral characteristics, staff responses, and treatments used, and to report on their prognosis over 6 months.
  
  
  METHODS
  A longitudinal cohort study.
  
  
  METHODS
  One hundred seven skilled nursing facilities.
  
  
  METHODS
  The 203 residents who were among the two most disruptive vocalizers in their respective facilities and who vocalized at least 2 hours a day.
  
  
  METHODS
  Telephone interviews of licensed nursing staff who cared for the subjects, conducted at baseline, 2, 4, and 6 months. Data gathered included subject demographics, physical function, diagnoses, medication and restraint use, behavioral problems, vocalization characteristics, treatments used, and status at follow-up.
  
  
  RESULTS
  Subjects tended to have dementia, to be dependent in most activities of daily living, to have multiple medical problems, to be physically restrained (48%), and to be taking psychotropic medication (76%). Nearly all (95%) were audible at least 50 feet away, with loudness associated with more severe cognitive impairment (OR 4.90, P = .001). When subjects who primarily made nonverbal noises ("screamers") were compared with those whose predominant expressions were words ("talkers"), hearing impairment, severe cognitive impairment, and greater dependency in activities of daily living characterized the screamers. Staff reported trying a variety of treatments with all subjects, often with little success. Two months after enrollment, 66% of surviving subjects vocalized fewer hours than at baseline, and 45% were rated as improved. Independent predictors of improvement included greater ADL independence, hearing and vision problems, shorter length of stay, urinary incontinence, and use of a treatment other than one-on-one interventions. Nearly one-quarter of subjects (23.4%) died within 6 months. Baseline factors associated independently with a higher probability of death included age, use of activity intervention, physical abusiveness, and absence of wandering.
  
  
  CONCLUSIONS
  Severe disruptive vocalization is associated with severe cognitive and physical impairment and with a high probability of mortality within 6 months. Subcategorization of severe vocalizers by vocalization type or other associated factors may be useful for prognostic and treatment purposes.
authors: Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, 27599, USA.
authors: P D
authors: PD
authors: Sloane
authors: S
authors: S
authors: Davidson
authors: N
authors: N
authors: Knight
authors: C
authors: C
authors: Tangen
authors: C M
authors: CM
authors: Mitchell
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000209:etiology* / Q000451:nursing* / Q000517:prevention & control; D009026:Mortality; D009740:Nursing Staff / Q000193:education / Q000523:psychology; D011379:Prognosis; D012307:Risk Factors; D012866:Skilled Nursing Facilities; D011795:Surveys and Questionnaires; D014705:Verbal Behavior