How to understand and respond to noise making in Dementia.
Updated: Oct 3, 2020
Characteristically, distress behaviour puts the safety of the person or others in some jeopardy or has a significant impact on the person's or other people's quality of life.
Understanding noise making
People with dementia will often create noise making which is a loud and persistent vocalising. This is often unintelligible and resistant to requests for silence by family, carers or professionals. It can include yelling, disruptive talk, melodic sounds, calling out, groaning. It can often be difficult to tolerate, but shouldn’t be regarded as a nuisance to be ignored, rebuked or isolated as there is usually a cause emanating from an unmet need.
Reasons for this noise making can be often one or some of the following
A communication of pain or physical discomfort. Environmental discomfort.
A response to unpleasant conditions. E.g. being in an uncomfortable chair, being cold. Talking to others.
Loud talking to others caused by unresponsiveness of the person being talked to. Words are discernable and the person will be gazing at somebody. Needs to be met.
Hunger, thirst, need for the toilet, wanting to go to bed. The most obvious sign of unmet need is ‘help me’.
Subject to hallucinations, the person may talk to or shout at someone/something seen which is real to them but not physically present. Under-stimulation.
Noise may provide self stimulation in an inactive world. Sensory deprivation may be compounded by poor vision/hearing. Shouting may be worse at night as the person lies awake in a frightened silence. Abandonment.
Calling out for a loved one indicates insecurity and feelings of loneliness. Prosopagnosia may heighten feelings of aloneness as familiar faces won’t be recognised. Everyone is a stranger.
Agitated shouting indicates the person is in distress. Shouting may be worse during care interventions when fear is greatest through being pushed, pulled, stripped, etc. Over-stimulation.
In response to a hectic, noisy environment or being bombarded with instructions, the person breaks into shouting which introduces a noise with which they can control. Busy moments may trigger calling out. Perseveration.
The person may get ‘stuck in a groove’ of shouting that they can’t easily get out of.
Attention seeking. If possessing the cognitive ability to manipulate others, noise making may be used to attract attention. If the person is only interacted with at times they are being disruptive, this may reinforce the behaviour.
The way we respond to this noise making is important to reduce the stress and anxiety that the person maybe experiencing. If we do not interact and reduce the levels of noise the situation could lead to more problematic distress behaviour including aggression.
Responding to noise making.
• Ensure that unmet needs are identified and respond., e.g. administer analgesia, move their position, move them to a quieter room, provide food/drink, toilet them.
• If hallucinating, reassure them they are safe, remove them to their room and it may stop. If they ask if they can see IT, say you can’t, but you know it is real to them. apologise for any upset.
• Provide stimulation to break into noise making and positively distract the person, e.g. with calming music, gentle hand massage, etc. This can help the perseverated shouting as well.
• If distressed and calling out for relatives, use validation approaches to calm the person down.
• Calm things down, turn off loud music, lower lighting, make the room less crowded. Record causes of sensory overload.
• Be careful that your approach and communication style is calming and supportive rather than threatening