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A Comparison of Two Treatments of Agitated Behavior in Nursing Home Residents With Dementia: Simulated Family Presence and Preferred Music

From the Department of Psychological Medicine (EB, BE, DO’C), Faculty of Medicine, Nursing and Health Sciences and the Department of Behavioral Studies (KG), Faculty of Arts, Monash University, Clayton, Victoria, Australia.

Objective: The objective of this study was to compare the effectiveness of two individualized psychosocial treatments in reducing the frequency of physically and verbally agitated behaviors in nursing home residents whose dementia was complicated by marked behavioral disturbance.

Methods: Thirty nursing home residents with frequent, severe behavioral disturbances were observed by research staff before, during, and after multiple, randomized, single-blind exposures to 15-minute audiotapes of simulated family presence (a conversation prepared by a family member about positive experiences from the past), music preferred by the resident in earlier life, and a placebo condition of a reading from a horticultural text. Selected (usually multiple) physical and verbal behaviors were counted as present or absent at regular intervals. All three treatment conditions were compared with usual care.

Results: Simulated presence and preferred music both proved effective in reducing counts of physically agitated behaviors. Simulated presence, but not music, resulted in significantly reduced counts of verbally agitated behaviors. The placebo tape proved more effective than expected. Participants’ responses to simulated presence and music varied widely. Behavior counts fell by one-half or more in many cases. Other residents became more agitated.

Conclusion: Participants’ better-than-expected responses to the placebo tape suggest that even the simplest technology can improve the lives of confused, disturbed nursing home residents. Of the two psychosocial treatments, preferred music tapes were easier to make and were clearly helpful in many instances. By contrast, family members often struggled to recall enough happy memories to compile a simulated presence tape. Simulated presence might prove just as effective if relatives speak on topics of their own choosing. Although not all residents were helped by these treatments, adverse effects were mild and shortlived.

Key Words: Dementia • agitation • psychological treatment • nursing home • family

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