By Vivien Lee
Alzheimer’s and other types of dementia often have what are known as behavioral and psychological symptoms of dementia (BPSD). These symptoms, which tend to occur in clusters, include wandering, disruptive sleep problems, resistance to care, agitation, aggression, delusions, hallucinations, and repetitive speech. These symptoms can be very upsetting for both the patient and the caregiver. In fact, behavioral symptoms are more difficult and disruptive for the patients and their caregivers than other symptoms of dementia, such as memory problems. Untreated behavioral symptoms can lessen caregivers’ quality of life, increase his or her risk of depression, and make it harder for them to provide care –which can increase the likelihood that the patient may be admitted to a nursing home.
Research has demonstrated that antipsychotic medications have little to no effect on many behavioral and psychological symptoms of dementia (BPSD).
Examples of BPSD Usually not Amenable to Antipsychotic Treatment
_ vocally disruptive behavior
_ Inappropriate urination/defecation
_ hiding and hoarding
_ eating inedible objects
_ inappropriate dressing/undressing
_ repetitive activity
_ tugging at seatbelts
_ pushing wheel chair bound residents
All behaviors have meaning. A non-drug approach to treating dementia-related symptoms suggests that behavioral symptoms may be due in part to unmet needs of the patient. For example, a person with dementia who continually repeats the same question over and over may be due to feeling insecure or unsafe, or not being able to engage meaningful in their environment. A non-drug treatment approach to this patient would include setting up a structured routine, providing reassurance (verbally or through touch), and engaging the person in activities that match his/her interest and abilities.
Studies show behavioral symptoms are often triggered by unmet needs.Today, dementia behaviors symptoms are being recognized as a form of communication that dementia patients attempt to respond to their current situation and communicate their unmet needs. Our understanding of the person behind the illness makes their behavior symptoms much easier to work with. Get to know the people you care for, their health needs. Some problems are really very simple but become incredibly complicated for not taking into account that dementia is a 24hr/day condition and lack of communication.
Non-pharmacological strategies should be person-centered and tailored to the individual. Interventions should be guided by the patient’s background, likes and dislikes, religious, cultural, and life experiences… etc. The following table listed a variety of behavioral interventions may be helpful. Standardized behavioral assessment tools should be used for evaluating behaviors to determine the effectiveness of psychosocial interventions.
Categories for Specific Non-Pharmacologic Interventions for BPSD
(a) Sensory Enhancement/Relaxation
· massage and touch
· individualized music
· controlled multisensory therapy
· art therapy
· aroma therapy
(b) Social Contact: Real or Simulated
· pet therapy
· simulated interactions; family videos
· individualized social contact
· 1:1 social interaction
(c) Behavior Therapy
· differential reinforcement
· stimulus control
(d) Structured Activities
· recreational activities
· outdoor walks
· physical activities
(e) Environmental Modifications
· natural wandering areas
· enhanced environments
· reduced stimulation
· light therapy
(f) Training and Development
· staff education (CARE program, P.I.E.C.E.S., proper communication)
· staff support
· training programs for family caregivers
Available medications aren’t particularly effective in treating behavioral symptoms associated with dementia. Drugs prescribed for these symptoms may cause serious side effects on dementia patients. Non-drug treatments are both safer and more effective. Studies suggest that a non-drug approach to treating dementia-related symptoms can help people with dementia and their caregivers.
A care plan that focuses on non-pharmacological interventions is considered best practice as the first-line management of most behavioral and psychological symptoms of dementia (BPSD). Often, simple, practical solutions and an awareness of the person’s preferences can make a big difference and help avoid turning to the use of medications to suppress behaviors. “Non-pharmacologic management of behavioral symptoms in dementia can significantly improve quality of life and patient-caregiver satisfaction,” write the authors, Laura N. Gitlin, PhD, Helen C. Kales, MD, and Constantine C. Lyketsos, MD, MHS.
This is a summary from the full report titled, “Best Practice Guideline for Accommodating and Managing Behavioral and Psychological Symptoms of Dementia (BPSD) in Residential Care – A Person-Centered Interdisciplinary Approach” It is in the Clinical Practice Guidelines and Protocols in BC ministry of health (MOH) publication, BC, Canada; October 25, 2012. The work was done in collaboration with expert physicians, nurses and those involved in the direct care of persons with dementia. http://www.health.gov.bc.ca/library/publications/year/2012/bpsd-guideline.pdf
1. Non-Drug Remedies Can Help Treat Behavioral Problems among Older Adults with Dementia November 21, 2012 issue of the Journal of the American Medical Association. Authored by Laura N. Gitlin, PhD, Helen C. Kales, MD, and Constantine C. Lyketsos, MD, MHS. http://www.healthinaging.org/resources/resource:non-drug-remedies-can-help-treat-behavioral-problems-among-older-adults-with-dementia/
2. Non-Pharmacological Treatment of Behavioral Problems in Dementia; Sarah Krieger-Frost RN MN Community Mental Health Nurse; Seniors Mental Health, Capital. http://www.gov.ns.ca/health/mhs/pubs/Non-PharmacologicalTreatmentofBehavioralProblemsinDementia.pdf
3. Management of Behavioral Problems in Dementia; Robert Kohn, MD, MPhil, and G. Mustafa Surti, MD. http://www.rimed.org/medhealthri/2008-11/2008-11-335.pdf
4. Managing behavioral and psychological symptoms in dementia Brian Lawlor, FRCPsych. http://bjp.rcpsych.org/content/181/6/463.full