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Psychological Treatment of Older Adults pp 127–145Cite as

Treatment in Residential Settings

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Part of the book series: The Springer Series in Adult Development and Aging ((SSAD))

Abstract

Geriatric behavioral disturbances present numerous difficulties for both the staff and the residents of nursing homes and other geriatric long-term care settings. Examples of these problematic behaviors include behavioral excesses, such as agitation, wandering, disruptive vocalization (DV) and physical aggression, and various behavioral deficits. Behavioral deficits, also referred to by geriatric health care professionals as “excess deficits” (Brody, Kleban, Lawton, & Silver-man, 1971), are symptoms of functional incapacity greater than that warranted by actual organic impairment. Such deficits can range from an absence of ambulation when the capability exists to urinary incontinence with no identifiable medical cause. Estimates of the prevalence of disruptive behaviors in nursing homes vary, depending on method of reporting and presence of dementia, but studies have found that between 64% (Zimmer, Watson, & Treat, 1984) and 83% of nursing home residents exhibit disruptive behaviors (Swearer, Drachman, O’Donnell, & Mitchell, 1988). It is further estimated that 73% of demented nursing home residents display at least one, if not several, aberrant behaviors (Cohen-Mansfield, 1986). Consequently, there is great interest among geriatric health care professionals in developing interventions for managing these behaviors.

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References

  • American Health Care Association (1990). The Long-Term Care Survey: Regulations, Forms, Procedures, Guidelines. Washington DC: CAT# 4697/UBP/2.5k/7/90.

    Google Scholar 

  • Baines, S., Saxby, P., & Ehlert, K. (1987). Reality orientation and reminiscence therapy: A controlled cross-over study of elderly confused people. British Journal of Psychiatry, 151, 222–231.

    Article  PubMed  Google Scholar 

  • Baltes, M. M., & Lascomb, S. L. (1975). Creating a healthy institutional environment for the elderly via behavior management. International Journal of Nursing Studies, 12, 5–12.

    Article  PubMed  Google Scholar 

  • Brickel, C. M. (1986). Pet-facilitated therapies: A review of the literature and clinical implementation considerations. Clinical Gerontologist, 5, 309–332.

    Article  Google Scholar 

  • Bright, R. (1987). The use of music therapy and activities with demented patients who are deemed “difficult to manage.” The elderly uncooperative patient. [Special issue]. Clinical Gerontologist, 6, 131–144.

    Article  Google Scholar 

  • Brody, E. M., Kleban, M. H., Lawton, M. P., & Silverman, H. A. (1971). Excess disabilities of mentally impaired aged: Impact of institutionalized treatment. Gerontologist, 11, 124–133.

    Article  PubMed  Google Scholar 

  • Brown, F. (1991). Creative daily scheduling: A nonintrusive approach to challenging behaviors in community residences. Journal of the Association for Persons with Severe Handicaps, 16, 75–84.

    Google Scholar 

  • Bumanis, A., & Yoder, J. W. (1987). Music and dance: Tools for reality orientation. “You bring out the music in me”: Music in nursing homes. [Special issue]. Activities, Adaptation and Aging, 10, 23–35.

    Article  Google Scholar 

  • Burgio, L. D., & Bourgeois, M. (1992). Treating severe behavior disorders in geriatric residential settings. Behavioral Residential Treatment, 7, 145–168.

    Google Scholar 

  • Burgio, L. D., & Burgio, K. L. (1986). Behavioral gerontology: Application of behavioral methods to the problems of older adults. Journal of Applied Behavior Analysis, 19, 321–328.

    Article  PubMed  Google Scholar 

  • Burgio, L. D., & Burgio, K. L. (1990). Institutional staff training and management: A review of the literature and a model for geriatric long-term care facilities. International Journal of Aging and Human Development, 30, 287–302.

    Article  PubMed  Google Scholar 

  • Burgio, L. D., & Lewis, T. (in press). Functional analysis and intervention in geriatric settings. In A. Repp & R. Homer (Eds.), Functional analysis of problem behavior: From effective assessment to effective support. Pacific Grove, CA: Brooks/Cole.

    Google Scholar 

  • Burgio, L. D., & Scilley, K. (1994). Caregiver performance in the nursing home: The use of staff training and management procedures. Seminars in Speech and Language, 15, 313–322.

    Article  Google Scholar 

  • Burgio, L. D., & Sinnott, J. (1989). Behavioral treatments and pharmacotherapy: Acceptability ratingsfor elderly individuals. Journal of Gerontology: Psychological Sciences, 44, 3–8.

    Google Scholar 

  • Burgio, L. D., & Sinnott, J. (1990). Behavioral treatments and pharmacotherapy: Acceptability ratings by elderly individuals in residential settings. Gerontologist, 30, 811–816.

    Article  PubMed  Google Scholar 

  • Burgio, L. D., Janosky, J., Sinnott, J., & Hohman, M. J. (1992). Acceptability of behavioral treatments and pharmacotherapy for geriatric behavioral disturbances: A comparison among health care professionals and consumer groups. Verhaltenstherapie, 2, 237–243.

    Article  Google Scholar 

  • Burgio, L. D., Sinnott, J., Janosky, J., & Hohman, M. J. (1992). Physicians’ acceptance of behavioral treatments and pharmacotherapy for behavioral disturbances in older adults. Gerontologist, 32, 546–551.

    Article  PubMed  Google Scholar 

  • Burgio, L., Scilley, K., Hoar, T., Washington, C., & Tunstall, A. (1993). Behavioral interventions for disruptive vocalizations in elderly nursing home residents with dementia. Gerontologist, 33, 110.

    Google Scholar 

  • Burgio, L. D., Scilley, K., Hardin, J. M., Janosky, J., Bonino, P., Slater, S. C., & Engberg, R. (1994a). Studying disruptive vocalization and contextual factors in the nursing home using computer-assisted real-time observation. Journal of Gerontology: Psychological Sciences, 49, P230–P239.

    Google Scholar 

  • Burgio, L. D., McCormick, K. A., Scheve, A. S., Engel, B. T., Hawkins, A., & Leahy, E. (1994b). The effects of changing prompted voiding schedules in the treatment of urinary incontinence in nursing home residents. Journal of the American Geriatrics Society, 42, 315–320.

    PubMed  Google Scholar 

  • Burgio, L. D., Hardin, M., Sinnott, J., Janosky, J., & Hohman, M. J. (1995a). Acceptability of behavioral treatments and pharmacotherapy for behaviorally disturbed older adults: Ratings of care-givers and relatives. Journal of Clinical Geropsychology, 1, 19–31.

    Google Scholar 

  • Burgio, L. D., Sinnott, J., Janosky, J., & Hohman, M. J. (1995b). Nurses’ acceptance of behavioral treatments and pharmacotherapy for behavioral disturbances in older adults. Applied Nursing Research, 8(4), 174–181.

    Article  PubMed  Google Scholar 

  • Burton, M. (1982). Reality orientation for the elderly: A critique. Journal of Advanced Nursing, 7, 427–433.

    Article  PubMed  Google Scholar 

  • Butler, F., Burgio, L., & Engel, B. (1987). A behavioral analysis of geriatric nursing home patients receiving neuroleptic medication: A comparative study. Journal of Gerontological Nursing, 13, 15–19.

    PubMed  Google Scholar 

  • Butler, R. N. (1961). The life review: An interpretation of reminiscence in the aged. Psychiatry, 26, 65–76.

    Google Scholar 

  • Cariaga, J., Burgio, L., Flynn, W., & Martin, D. (1991). A controlled study of disruptive vocalizations among geriatric residents in nursing homes. Journal of the American Geriatrics Society, 39, 501–507.

    PubMed  Google Scholar 

  • Carstensen, L. L. (1988). The emerging field of behavioral gerontology. Behavior Therapy, 19, 259–281.

    Article  Google Scholar 

  • Christie, M. E. (1992). Music therapy applications in a skilled and intermediate care nursing home facility: A clinical study. Activities, Adaptation & Aging, 16, 69–87.

    Article  Google Scholar 

  • Citrin, R. S., & Dixon, D. N. (1977). Reality orientation, a therapy for psychogeriatric patients: A controlled study. Gerontologist, 16, 69–76.

    Google Scholar 

  • Clair, A. A., & Bernstein, B. (1990). A preliminary study of music therapy programming for severely regressed persons with Alzheimer’s-type dementia. Journal of Applied Gerontology, 9, 299–311.

    Article  Google Scholar 

  • Cohen-Mansfield, J. (1986). Agitated behaviors in the elderly: II. Preliminary results in the cognitively deteriorated. Journal of the American Geriatrics Society, 34, 722–727.

    PubMed  Google Scholar 

  • Coons, D. H., & Spencer, B. (1983). The older person’s response to therapy: The in-hospital therapeutic community. Psychiatric Quarterly, 55, 156–172.

    Article  PubMed  Google Scholar 

  • Evans, L. K., & Strumpf, N. E. (1989). Tying down the elderly: A review of the literature on physical restraint. Journal of the American Geriatrics Society, 36, 65–74.

    Google Scholar 

  • Ferrano, E., Cappa, G., Molaschi, M., Rocco, M., & Fabris, F. (1991). Reality orientation therapy in institutionalized elderly patients: Preliminary results. Archives of Gerontology and Geriatrics, suppl. 2, 139–142.

    Google Scholar 

  • Folmar, S., & Wilson, H. (1989). Social behavior and physical restraints. Gerontologist, 29, 650–653.

    Article  PubMed  Google Scholar 

  • Folsom, J. (1968). Reality orientation for the elderly mental patient. Journal of Geriatric Psychiatry, 1, 291–307.

    Google Scholar 

  • Gammonley, J., & Yates, J. (1991). Pet projects: Animal assisted therapy in nursing homes. Journal of Gerontological Nursing, 17, 12–15.

    PubMed  Google Scholar 

  • Goldwasser, A. N., Auerbach, S. M., & Harkins, S. W. (1987). Cognitive, affective, and behavioral effects of reminiscence group therapy on demented elderly. International Journal of Aging and Human Development, 25, 209–222.

    Article  PubMed  Google Scholar 

  • Gropper-Katz, E. I. (1987). Reality orientation research. Journal of Gerontological Nursing, 13, 13–18.

    PubMed  Google Scholar 

  • Haughie, E., Milne, D., & Elliott, V. (1992). An evaluation of companion pets with elderly psychiatric patients. Behavioral Psychotherapy, 20, 367–372.

    Article  Google Scholar 

  • Hewett, L. J., Asamen, J. K., Hedgespeth, J., & Dietch, J. T. (1991). Group reminiscence with nursing home residents. Clinical Gerontologist, 10, 69–72.

    Google Scholar 

  • Hoodin, F., & Fatis, M. (1989). Differential reinforcement to reduce excessive requests for toileting assistance of a geriatric nursing home resident. Clinical Gerontologist, 9, 15–29.

    Article  Google Scholar 

  • Hussian, R. A. (1981). Geriatric psychology: A behavioral perspective. New York: Van Nostrand Reinhold.

    Google Scholar 

  • Hussian, R. A. (1987). Wandering and disorientation. In L. L. Carstensen & B. A. Edelstein (Eds.), Handbook of clinical gerontology (pp. 177–189). New York: Pergamon.

    Google Scholar 

  • Hussian, R. A. (1988). Modification of behaviors in dementia via stimulus manipulation. Clinical Gerontologist, 8, 37–43.

    Article  Google Scholar 

  • Hussian, R. A., & Brown, D. C. (1987). Use of two-dimensional grid patterns to limit hazardous ambulation in demented patients. Journal of Gerontology, 42, 558–560.

    Article  PubMed  Google Scholar 

  • Hussian, R. A., & Davis, R. L. (1985). Responsive care: Behavioral interventions with elderly persons. Champaign, IL: Research Press.

    Google Scholar 

  • Ingstad, P. J., & Gotestam, K. G. (1987). Staff attitude changes after environmental changes on a ward for psychogeriatric patients. International Journal of Social Psychiatry, 33, 237–244.

    Article  PubMed  Google Scholar 

  • Jencks, S. F., & Clausen, S. B. (1991). Managing behavior problems in nursing homes. Journal of the American Medical Association, 265, 502–503.

    Article  PubMed  Google Scholar 

  • Kornreich, S. (1988). An Alzheimer patient’s use of art as a form of constancy. Pratt Institute Creative Arts Therapy Review, 9, 29–39.

    Google Scholar 

  • Langer, E. J., & Rodin, J. (1976). The effects of choice and enhanced personal responsibility for the aged: A field experiment in an institutional setting. Journal of Personality and Social Psychology, 34, 191–198.

    Article  PubMed  Google Scholar 

  • Lappe, J. M. (1987). Reminiscing: The life review therapy. Journal of Gerontological Nursing, 13, 12–16.

    PubMed  Google Scholar 

  • Lesser, J., Lazarus, L. W., Frankel, R., & Havasy, S. (1981). Reminiscence group therapy with psychotic geriatric inpatients. Gerontologist, 21, 291–296.

    Article  PubMed  Google Scholar 

  • Lichtenberg, P. A. (1990). Reducing excess disabilities in geropsychiatric inpatients: A focus on behavioral problems. Mental health in the nursing home. [Special issue]. Clinical Gerontologist, 9, 65–76.

    Article  Google Scholar 

  • Lundervold, D. A., & Jackson, T. (1992). Use of applied behavior analysis in treating nursing home residents. Hospital and Community Psychiatry, 43, 171–173.

    PubMed  Google Scholar 

  • Mango, C. (1992). Emma: Art therapy illustrating personal and universal images of loss. Omega, 25, 259–269.

    Google Scholar 

  • McCulloch, M. J. (1985). Pets in therapeutic programs for the aged. Journal of the Delta Society, 2, 34–44.

    Google Scholar 

  • McEvoy, C. (1989). Behavioral treatment. In J. Cummings & B. Miller (Eds.), Alzheimer’s disease: Treatment and long-term management (pp. 207–224). New York: Marcel Dekker.

    Google Scholar 

  • Millard, K. A. O., & Smith, J. M. (1989). The influence of group singing therapy on the behavior of Alzheimer’s disease patients. Journal of Music Therapy, 26, 58–70.

    PubMed  Google Scholar 

  • Mullins, C. S., Nelson, D. L., & Smith, Doris A. (1987). Exercise through dual-purpose activity in the institutionalized elderly. Physical and Occupational Therapy in Geriatrics, 5, 29–39.

    Article  Google Scholar 

  • Mullins, D. W., & Overstreet, L. L. (1984). Effects of milieu therapy on the chronically ill geriatric patient. American Corrective Therapy Journal, 38, 115–118.

    Google Scholar 

  • Newton, N. A., & Lazarus, L. W. (1992). Behavioral and psychotherapeutic interventions. In J. E. Birren, R. B. Sloane, & G. D. Cohen (Eds.), Handbook of mental health and aging (2nd Ed.). (pp. 699-719). San Diego: Academic Press.

    Google Scholar 

  • Ohta, R. J., & Ohta, B. M. (1988). Special units for Alzheimer’s disease patients: A critical look. Gerontologist, 28, 803–808.

    Article  PubMed  Google Scholar 

  • Orten, J. D., Allen, M., & Cook, J. (1989). Reminiscence groups with confused nursing center residents: An experimental study. Social Work in Health Care, 14, 73–86.

    Article  PubMed  Google Scholar 

  • Pohl, J., & Fuller, S. (1980). Perceived choice, social interaction, and dimensions of morale of residents in a home for the aged. Research in Nursing and Health, 3, 147–157.

    Article  PubMed  Google Scholar 

  • Pollack, N. J., & Namazi, K. H. (1992). The effect of music participation on the social behavior of Alzheimer’s disease patients. Journal of Music Therapy, 29, 54–67.

    Google Scholar 

  • Powell-Proctor, A., & Miller, J. S. (1982). Reality orientation: A critical appraisal. British Journal of Psychiatry, 140, 457–463.

    Article  PubMed  Google Scholar 

  • Rabinovich, B. A., & Cohen-Mansfield, J. (1992). The impact of participation in structured recreational activities on the agitated behavior of nursing home residents: An observational study. Activities, Adaptation & Aging, 16, 89–98.

    Article  Google Scholar 

  • Rader, J. (1987). A comprehensive staff approach to problem wandering. Gerontologist, 27, 756–760.

    Article  PubMed  Google Scholar 

  • Rapp, M. S., Flint, A. J., Herrmann, N., & Proulx, G. (1992). Behavioural disturbances in the demented elderly: Phenomenology, pharmacotherapy and behavioural management. Canadian Journal of Psychiatry, 37, 651–657.

    Google Scholar 

  • Ray, W. A., Federspiel, C. F., & Schaffner, W. (1980). Antipsychotic drug use in nursing homes: Evidence of misuse. American Journal of Public Health, 70, 485–491.

    Article  PubMed  Google Scholar 

  • Schantz, P. M. (1990). Preventing potential health hazards incidental to the use of pets in therapy. Anthrozoos, 4, 14–23.

    Article  Google Scholar 

  • Schneider, L. S., Pollock, V. E., & Lyness, S. A. (1990). A meta-analysis of controlled trials of neuro-leptic treatment in dementia. Journal of the American Geriatrics Society, 38, 553–563.

    PubMed  Google Scholar 

  • Short, L., & Leonardelli, C. A. (1987). The effects of exercise on the elderly and implications for therapy. Physical and Occupational Therapy in Geriatrics, 5, 65–73.

    Article  Google Scholar 

  • Smith, G. H. (1986). A comparison of the effects of three treatment interventions on cognitive functioning of Alzheimer patients. Music Therapy, 6, 41–56.

    Google Scholar 

  • Smith-Marchese, K. (1994). The effects of participatory music on the reality orientation and sociability of Alzheimer’s residents in a long-term care setting. Activities, Adaptation and Aging, 18, 41–55.

    Article  Google Scholar 

  • Sommer, R., & Ross, H. (1958). Social interaction on a geriatrics ward. International Journal of Social Psychiatry, 4, 128–133.

    Article  Google Scholar 

  • Spayd, C. S., & Smyer, M. A. (1988). Interventions with agitated, disoriented, or depressed residents. In M. A. Smyer, M. D. Cohn, & D. Brannon (Eds.), Mental health constitution in nursing homes (pp. 123–141). New York: New York University Press.

    Google Scholar 

  • Steer, R. A., & Boger, W. P. (1975). Milieu therapy with psychiatric medically infirm patients. Gerontologist, 15, 138–141.

    Article  PubMed  Google Scholar 

  • Swearer, J. M., Drachman, D. A., O’Donnell, B. F., & Mitchell, A. L. (1988). Troublesome and disruptive behaviors in dementia: Relationships to diagnosis and disease severity. Journal of the American Geriatrics Society, 36, 784–790.

    PubMed  Google Scholar 

  • Vaccaro, F. J. (1988). Application of opérant procedures in a group of institutionalized aggressive elderly subjects. Psychology and Aging, 3, 22–28.

    Article  PubMed  Google Scholar 

  • Wald, J. (1986). Art therapy for patients with dementing illnesses. Clinical Gerontologist, 4, 29–40.

    Article  Google Scholar 

  • Wanlass, W., & Culver, S. (1990). Behavior modification in a demented nursing home patient. Paper presented at the annual meeting of AGS/AFAR, May, 1990, Atlanta, GA.

    Google Scholar 

  • Winnett, R. L. (1989). Long-term care reconsidered: The role of the psychologist in the geriatric rehabilitation milieu. Journal of Applied Gerontology, 8, 53–68.

    Article  Google Scholar 

  • Zimmer, J. G., Watson, N. G., & Treat, A. (1984). Behavioral problems among patients in skilled nursing facilities. American Journal of Public Health, 76, 1118–1121.

    Article  Google Scholar 

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Authors and Affiliations

  1. Center for Aging, Division of Gerontology and Geriatric Medicine, and Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, 35294, USA

    Louis D. Burgio, Ellen M. Cotter & Alan B. Stevens

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  1. Louis D. Burgio
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  2. Ellen M. Cotter
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  3. Alan B. Stevens
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  1. Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, Florida, 33314, USA

    Michel Hersen  & Vincent B. Van Hasselt  & 

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Burgio, L.D., Cotter, E.M., Stevens, A.B. (1996). Treatment in Residential Settings. In: Hersen, M., Van Hasselt, V.B. (eds) Psychological Treatment of Older Adults. The Springer Series in Adult Development and Aging. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-0295-5_7

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