3 steps to decrease antipsychotic drug use with activities and programming

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3 steps to decrease antipsychotic drug use with activities and programming

Posted on May 27, 2013

Around 90 percent of people with dementia experience aggression, agitation and psychosis (delusions and hallucinations). These symptoms are known as behavioral and psychological symptoms of dementia and can be very distressing for the person with dementia, their family and others who may be providing care.

A common cause of these symptoms is the use of antipsychotic drugs. In early 2012, the FDA warned that treatment with antipsychotic drugs increases the risk of death among elderly patients with dementia, and now a new study confirms that some drugs are riskier than others. CMS partnered with the American Health Care Association’s Quality Initiative, which called for a 15% reduction in antipsychotic use in nursing homes by the end of 2012. Providers fell far short of that goal, AHCA recently announced.

There are a number of simple treatment and therapy options that can reduce the instance of behavioral and psychological symptoms without the need for medication. These are based on the principles of person-centered care which staff can offer by:

1. Understanding the source of the behavior:

Get details about the resident’s behavioral expressions of distress (nature, frequency, severity, and duration) and the risks of those behaviors, and discuss potential underlying causes with the care team and family. Before medication is considered, any person with dementia who develops behavioral and psychological symptoms should be offered an assessment by a caregiver as soon as possible. This assessment should try to establish any possible underlying factors that may have triggered or may be aggravating the person’s symptoms. It is important to ensure that the person with dementia is physically healthy, comfortable and well cared for.

2. Filtering out avoidable causes of behaviors

Exclude potentially remediable causes of behaviors such as:

  • B12 Folic Acid Deficiency
  • Infection
  • Hunger/thirst
  • Nocturia
  • Hypercalcemia
  • Pain
  • Hypothyroidism
  • Constipation
  • Medication/Drug induced delirium

Once the potential causes are excluded, one should determine if symptoms are severe, distressing or risky enough to adversely affect the safety of residents.

3. Introducing activities and programming with a person centered approach

Try environmental and other approaches that attempt to understand and address behavior as a form of communication in persons with dementia, and modify the environment and daily routines to meet the person’s needs. Simple non-drug treatments, such as reminiscence therapy and social interaction, can also prevent the need for drugs. For example, research suggests that some symptoms can be reduced by just 10 minutes of one-to-one time each day. A recent study also demonstrated that recognizing and treating pain can significantly reduce agitation and aggression in people with dementia. Other examples of treatments include aromatherapy, talking therapies, animal therapy, music and dance therapy and massage. Here are the basic elements needed in any strategy:

a)     Treating the person with dignity and respect

b)    Understanding their history, lifestyle, culture and preferences,

c)     Including their likes, dislikes, hobbies and interests

d)    Looking at situations from the point of view of the person with dementia

e)     Providing opportunities for the person to have conversations and relationships with other people

f)     Ensuring the person has the chance to try new things or take part in activities they enjoy.

g)    The person should also be helped to lead an active life, with interesting and stimulating daily activities. In this way it is often possible to avoid the use of drugs altogether.