Older adults with complex medical disorders (dementia, serious mental illness, multiple chronic medical conditions) may have a high prevalence of distress behaviors (eg, physical or verbal aggression, repeated vocalizations, disengagement). For example, among patients with dementia, 75% exhibit at least 1 neuropsychiatric symptom. Across health care settings, these symptoms are often manifestations of patient distress and may be uncomfortable for both patients and their paid caregivers. Exacerbation of these symptoms is likely due to vulnerability to environmental factors such as under- or over-stimulation, or unmet medical, physical, emotional, and social needs. Moreover, these symptoms may be unintentionally reinforced by staff or care routines. Patient distress behaviors can impact patient quality of life, care provision, cost of care, or transition to community-based care settings.
