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Effects of Behavioral Interventions on Disruptive Behavior and Affect in Demented Nursing Home Residents

Beck, Cornelia K.; Vogelpohl, Theresa S.; Rasin, Joyce H.; Uriri, Johannah Topps; O’Sullivan, Patricia; Walls, Robert; Phillips, Regina; Baldwin, Beverly


Background Disruptive behaviors are prevalent in nursing home residents with dementia and often have negative consequences for the resident, caregiver, and others in the environment. Behavioral interventions might ameliorate them and have a positive effect on residents’ mood (affect).

Objectives This study tested two interventions—an activities of daily living and a psychosocial activity intervention—and a combination of the two to determine their efficacy in reducing disruptive behaviors and improving affect in nursing home residents with dementia.

Methods The study had three treatment groups (activities of daily living, psychosocial activity, and a combination) and two control groups (placebo and no intervention). Nursing assistants hired specifically for this study enacted the interventions under the direction of a master’s prepared gerontological clinical nurse specialist. Nursing assistants employed at the nursing homes recorded the occurrence of disruptive behaviors. Raters analyzed videotapes filmed during the study to determine the interventions’ influence on affect.

Results Findings indicated significantly more positive affect but not reduced disruptive behaviors in treatment groups compared to control groups.

Conclusions The treatments did not specifically address the factors that may have been triggering disruptive behaviors. Interventions much more precisely designed than those employed in this study require development to quell disruptive behaviors. Nontargeted interventions might increase positive affect. Treatments that produce even a brief improvement in affect indicate improved quality of mental health as mandated by federal law.

Cornelia K. Beck, PhD, RN, is Professor, Colleges of Medicine and Nursing, University of Arkansas for Medical Sciences.

Theresa S. Vogelpohl, MNSc, RN, is President, ElderCare Decisions.

Joyce H. Rasin, PhD, RN, is Associate Professor, School of Nursing, University of North Carolina.

Johannah Topps Uriri, PhD(c), RN, is Clinical Assistant Professor, College of Nursing, University of Arkansas for Medical Sciences.

Patricia O’Sullivan, EdD, is Associate Professor, Office of Educational Development, University of Arkansas for Medical Sciences.

Robert Walls, PhD, is Professor Emeritus, University of Arkansas for Medical Sciences.

Regina Phillips, PhD(c), RN, is Assistant Professor, Nursing Villa Julie College.

Beverly Baldwin, PhD, RN, deceased, was Sonya Ziporkin Gershowitz Professor of Gerontological Nursing, University of Maryland.

Editor’s Note: Information provided by the author expanding this article is at

Accepted for publication September 28, 2001.

The National Institutes of Health, National Institute on Aging provided funding (#R01 AG10321) for this project.

The authors thank Valorie M. Shue, BA, for her assistance, especially her thorough editing of the final draft of this manuscript.

Corresponding author: Cornelia K. Beck, PhD, RN, FAAN, Department of Geriatrics, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 808, Little Rock, AR 72205 (e-mail:

Note to Readers: This article employs a number of acronyms. Refer to Table 1 to facilitate reading.



© 2002 Lippincott Williams & Wilkins, Inc.