NON-DRUG INTERVENTIONS FOR DEMENTIA: 6 STEPS TO DECREASING CHALLENGING BEHAVIORS

Perhaps you're interested in trying some non-drug interventions with a patient or a loved one who has dementia. Although some medications can be helpful in treating the challenging behaviors of Alzheimer's or another dementia, approaches that don't involve medicines should always be the first line of defense. But, do you know where to start?

Some Nursing Professors from Johns Hopkins University are here to help. They published a set of guidelines that outline six steps to take when using non-pharmacological approaches to address behavior challenges in dementia. These guidelines include the following:

1.   Screen for Behavioral Symptoms Early

Try to catch the symptoms in the early stages. You might think that a bout of restlessness is just a short phase, but after someone starts wandering out the door is not a good time to start trying interventions for the first time.

2.   Identify Symptoms.

This may seem like an obvious step, but it's an important one. Taking the time to specifically label behaviors is helpful, especially when the person has more than one challenging behavior.

3.   Delineate the Triggers and Risk Factors for the Symptoms

Look at what precedes the behavior and could be causing it. Consider the following triggers:

•     Environmental Causes

•     Psychological/Cognitive Causes

•     Physical Causes

Also, identify the possible outcome of the behavior.

4.   Choose the Proper Interventions

According to the Johns Hopkins School of Nursing, "an individual with dementia might wake repeatedly each night, voicing fear of being alone in the dark, despite continuous calming efforts. An intervention might mean simply using a nightlight in the patient’s room, or adding long family walks in the evening, to help promote better sleep."

5.   Evaluate the Intervention to make sure that it’s working.

Documenting the behavior and the intervention, as well as the effectiveness of the intervention can prevent you from errors in recall. For example, remembering the one time the intervention didn't work because that stands out in your mind but not the five times it was effective can warp your accuracy and cause you to discontinue an approach that actually may be quite helpful. You can also note the time of day that the behaviors occurred to determine if there's a pattern in the timing.

6.   Follow the Patient’s Progress Over Time

The behaviors of people with dementia often change over time, necessitating a re-evaluation of the above steps. As Alzheimer's disease progresses through the different stages, new behaviors can emerge and previous ones may resolve.

Remaining committed over time to the primary use of non-drug approaches requires an intentional switch in perspective. Rather than thinking immediately about which medication might be effective, train yourself to think about these six steps and make changes in the environment or care of the person first.

Finally, it's important to note that there are some symptoms or circumstances that may necessitate the use of medications, such as the continual presence of distressing hallucinations, delusions, or paranoia. The goal in dementia care is the care and comfort of the person, so if non-drug interventions aren't facilitating that, medications may need to be utilized and then carefully monitored.

(Source:  about.com, Alzheimer’s/Dementia)