Psychotropic medications do have a place in the treatment of dementia patients, Helen Kales, M.D., an associate professor of psychiatry at the University of Michigan and a geriatric psychiatrist, told
Psychiatric News (see
Steep Decline Found in Use of Antipsychotics for Dementia). But another approach to dealing with problem behaviors often exhibited by dementia patients "may be behavior management of symptoms, managing the caregiving environment, and reserving medications for those cases where the symptoms are severe and impair function," she asserted.
Yet how might problem behaviors in dementia patients be handled from a behavioral standpoint? Some promising approaches are being tested by Laura Gitlin, Ph.D., a professor of nursing at the Johns Hopkins University School of Nursing, Kales said.
For example, the most common problem behaviors exhibited by dementia patients are arguing, repetitive questioning, and resisting efforts to provide care for them, Gitlin and her colleagues reported in the August 2010 Journal of the American Geriatrics Society.
Less common but still troubling behaviors include waking up at night, toileting problems, verbal aggression, wandering or trying to leave home, and agitation. The least common ones include shadowing, physical aggression, and hallucinations.
Gitlin and her colleagues thought that an effective way of responding to such behaviors might be to target the one that is most troubling and come up with a way of dealing with it. They tested their hypothesis in a study that included 272 dementia patients and their caregivers.
Half of the patients and caregivers were placed in an intervention group, the remainder in a no-treatment control group. Each caregiver in the intervention group was visited by an occupational therapist or nurse periodically over a 16-week period to help him or her identify the major problem behavior, determine the cause or causes, and brainstorm possible strategies for dealing with the problem.
For example, if a patient was waking up at night, a caregiver and therapist might explore possible causes—the patient was not getting enough exercise during the day or drinking too much liquid before going to bed, or there was too much light coming through the bedroom window. If the caregiver and therapist decided that light was the problem, then the caregiver could make sure that the bedroom window shade was pulled down before the patient went to sleep.
After the caregiver decided on an action plan, the therapist or nurse helped that person practice it. From weeks 16 to 24, a therapist or nurse called the caregiver to reinforce use of the action plan.
Caregivers in the intervention group and control group were then evaluated to see how things were going as far as patient problem behaviors were concerned. They found that 68 percent of intervention-group caregivers reported improvement in the major problem behavior, while only 46 percent of control-group caregivers did so, a highly significant difference. In addition, caregivers in the intervention group reported being significantly less upset with the problem behaviors of the dementia patient, experiencing significantly less burden from caregiving responsibilities, and having a significantly higher level of well-being than control caregivers did.
