The purpose of this individual National Research Service Award (NRSA) application is to provide the applicant with essential research training to become an independent investigator focusing on behavioral symptoms of dementia, more specifically persistent vocalizations (PVs) (otherwise known as disruptive vocalizations or problematic vocalizations). This NRSA will ensure that the applicant achieves competence in the methodological and analytical skills to conduct ethically sound research with the vulnerable population of older adults with dementia. From her clinical experience as a Registered Nurse in nursing homes (NH), the applicant has first-hand knowledge of how distressing PVs are for other residents, staff, and visitors including family members and how PVs decrease the quality of life for the NH resident(s) with PVs themselves. Prevalence rates among NH residents with dementia and PVs are as high as 81%. Without a deeper understanding of the underlying cause of PVs, nursing staff are unable to effectively prevent or manage them. The overall purpose of this innovative, mixed methods research project is to use physiological measures and observational data to describe persons with moderate to severe dementia and PVs. Using the Needs-driven Dementia-compromised Behavior model as a framework, the applicant will examine the proximal factors (physiological and psychosocial needs states, physical environment and social environment factors) that lead to PVs. Having a greater understanding of PVs and their causes can enable the development and testing of tailored interventions to reduce them. This is the first known study to investigate potential physiological indictors prior t, during and after a PV episode. These physiological data will be combined with other source data including qualitative analysis of video recordings and field notes, noise decibel readings and 3 observational measurement scales to characterize the period prior to, during, and after PV episodes. The applicant's research training will be guided by a mentoring team including Dr. Mary Ersek, a well-known researcher in long term care and pain in persons with dementia; Dr. Pamela Cacchione, a sensory impairment, delirium and dementia expert; Dr. Cornelia Beck, an expert on dementia and persons with dementia and PVs; and Dr. Joseph Libonati, an exercise physiologist with expertise in the use of the BioHarness System that will be used to collect physiological data. This research addresses the priority of the National Institute of Nursing Research on symptom management because it proposes to investigate PVs to build the evidence toward successful symptom management of this challenging behavioral symptom of dementia. The specific research and methodological approach proposed in this application has wide applicability to many stakeholders, including formal and informal caregivers, residents with dementia and behavioral symptoms, nursing home administrators and other researchers exploring behavioral symptoms.
This training award will further the applicant's achievement of becoming an independent nurse scientist by gaining a better understanding of one of the most common and complex behavioral symptoms of moderate to severe dementia - persistent vocalizations (PVs) (otherwise known as disruptive vocalizations or problematic vocalizations). Prevalence rates among nursing home (NH) residents with dementia and PVs are as high as 81% which translates to approximately 1.6 million NH residents exhibiting PVs at some point. This study is the first step in understanding the physiological, social and environmental determinants of PVs to guide the development of tailored interventions to improve the quality of life for NH residents, decrease caregiver stress as well as help nurses and NH staff manage this complex symptom.
