PROBLEMATIC VOCALIZATIONS--BACKROUND AND PROXIMAL FACTOR

痴呆症患者经常表现出有问题的发声和其他与痴呆症相关的行为，这些行为使环境中的其他人感到困惑，沮丧或烦恼。 这些行为通常会给患者带来负面影响，而护理人员缺乏基于理论的干预措施来解决这些问题。 基于广泛的文献综述，我们的互动研究项目组已将其重新概念化为基于需求的痴呆妥协行为（NDB），我们现在建议检查预测哪些痴呆症患者最有可能显示它们以及在什么条件下最有可能发生的变量。我们的研究的目的，三个互动项目之一，是开发一个初步的解释性模型的问题发声，将作为有针对性的干预措施，最终将提高生活质量的实证测试的基础痴呆症患者和他们的照顾者。 我们的具体目标是：1）建立一个影响痴呆患者问题发声的背景（相对稳定）和邻近（更易变化）变量模型; 2）评估我们对问题发声的测量的收敛效度;使用科恩-曼斯菲尔德激越量表的言语激越行为。 采用多变量横断面描述性设计，我们将从9个随机选择的养老院招募236名居民的集群样本。 背景变量的措施包括体检和仪器与参与者和同意的家庭线人。 近端变量的测量包括图表审查，询问参与者，评估环境氛围，以及参与者运动的机械测量，环境光，噪音和热指数。 问题发声的测量将来自14个10分钟观察期间的录像带和录音带。分层线性建模将被用来测试有问题的发声模型。 由此产生的初步模型将在为相关项目获得的两个独立样本中进一步测试。 此外，来自三个互动项目中共同的一组核心背景和邻近因素的数据将被结合起来，以开发一个在一般情况下产生NDB的因素模型。

Persons with dementia display frequent problematic vocalizations and other dementia-related behaviors that perplex, dismay, or annoy others in the environment. These behaviors often lead to negative consequences for the patient, and caregivers lack theoretically-based interventions to address them. Based on an extensive literature review, our interactive research project group has reconceptualized them as need-based dementia-compromised behaviors (NDBs) and we now propose to examine variables that predict which persons with dementia are most at risk for displaying them and under what conditions they are most likely to occur. The purpose of our study, one of a trio of interactive projects is to develop a preliminary explanatory model of problematic vocalizations that will serve as a basis for empirical testing of targeted interventions that ultimately will improve the quality of life for persons with dementia and their caregivers. Our specific aims are to: 1) develop a model of background (relatively stable) and proximal (more changeable) variables affecting problematic vocalizations in persons with dementia; and 2) assess convergent validity of our measures of problematic vocalizations; with the verbally agitated behaviors of the Cohen- Mansfield Agitation Inventory. Using a multivariate cross-sectional descriptive design, we will enroll a cluster sample of 236 residents from nine randomly selected nursing homes. Measures of background variables include physical examination and instrumentation with participants and a consenting family informant. Measures of proximal variables include chart review, questioning of participants, assessment of environmental ambiance, and mechanical measurements of participants' movement, environmental light, noise, and heat index. Measures of problematic vocalizations will come from videotapes and audiotapes made during 14 ten-minute observations. Hierarchical linear modeling will be used to test a model of problematic vocalizations. The resulting preliminary model will be further tested in two independent samples obtained for the accompanying projects. Further, data from a core set of background and proximal factors common across the three interactive projects will be combined to develop a model of factors operative in producing NDBs in general.