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Options for Managing Behaviour Complications of Dementia: Presented at AAGP By Carole VanSickle Ellis SAVANNAH, Ga -- March 9, 2010 -- Healthcare professionals and caregivers of patients with Alzheimer’s disease and dementia living in nursing facilities may benefit from strategies for dealing with dementia and related behaviour complications that have little to do with medication. Amita Patel, MD, Wright State University, Dayton, Ohio, and Yadagiri Chepuru, Healthcare System, Yonkers, New York, revealed the results of several years’ worth of analysis and carefully implemented changes in nursing facilities in the New York area here on March 8 at the 2010 Annual Meeting of the American Association for Geriatric Psychiatry (AAGP). Even though Alzheimer’s and dementia patients are not necessarily rooted in reality, their symptoms do have an origin, stated the research team. This origin is often environmental, and may stem from a lack of communication, chronically unfamiliar circumstances, intrusive care, loss of control, and chronic pain and discomfort. These issues are often compounded by classic dementia behaviour complications like disinhibition, paranoia, hallucinations, delusions, and aggressive behaviour. Consequences of these behaviour complications often include falls, injuries to the patient, bystanders and caregivers, practitioner malpractice burden, legal issues, and significant caregiver burden. Understanding the source of the behaviour issues -- even if that source is not entirely logical or even rooted in reality -- can enable a caregiver and a physician to develop long-term, effective, and personalised solutions to behaviour problems that result in a better quality of life for everyone involved. The team identified triggers for behavioural complications of dementia. These include: · Pain: Patients with dementia may not be properly medicated for this pain because of their inability to express discomfort adequately. · Emotional issues: Not only is dementia frustrating, but lack of consistency can cause severe distress. · Psychiatric: This category includes delusions, hallucinations, and paranoia. While these may only be treatable with medication, in some cases they can be resolved by flexibility on the part of primary caregivers. For example, instead of trying to recall a patient to reality who insists that children are running around her room, informing her that you have taken the children home where you can take care of them. “Reality orientation is the worst thing you can do with many of these patients,” said Dr. Patel. · Environmental: Many simple issues that may seem routine in a nursing facility such as calls over an intercom throughout the day or night, can frighten patients and trigger aggressive behaviour. · Interpersonal: Alzheimer’s and dementia patients may have difficulty understanding others or expressing themselves. · Medicinal: The team found that many patients were over-prescribed. “Each medication should be treating a specific diagnosis, and when possible, gradual dose reduction can be beneficial, particularly in the case of antipsychotic medicines,” said Dr. Chepuru. · ADL (Activity of Daily Living) Challenges: Frustration, anger, and incomprehension regarding inability to complete daily, personal tasks such as bathing or going to the bathroom can create serious aggression, particularly if the patients perceive themselves to have lost control over these functions to another person. The researchers believe that by identifying potential triggers for patients, caregivers, and staff can be better prepared to deal with episodes. Funding for this research was provided by Forest Laboratories, Pfizer, AstraZeneca, Wyeth, Eli Lilly, and sanofi-aventis. [Presentation title: Treatment of Behavior Complications of Dementia: A Comprehensive, Multi-Disciplinary Care Approach. Abstract S39] E-mail this page to a friend or colleague! To print, use this version