Dementia and Alzheimer’s care through an Individualized approach

We begin to develop individual patterns of behavior at birth we know what others mean by listening to what they say and watching what they do. In the absence of verbal communication we possess the ability to understand what others are communicating. If we lose the ability to speak our actions become our method of communication.

In the United States, 25.2 percent of nursing facility residents receives antipsychotic medications, according to data from the Online Survey Certification and Reporting Database (OSCAR) from the Centers for Medicare and Medicaid Services (CMS). In the nursing facility resident population, antipsychotics are generally used for three purposes:

•Treatment of psychotic disorders.

•Treatment of psychotic symptoms associated with other conditions such as Alzheimer’s disease or delirium.

•Treatment of behavioral and psychological symptoms associated with dementia (BPSD), when these symptoms present a risk of harm to the resident or others.

Antipsychotics are also occasionally used for other purposes, such as in conjunction with an antidepressant in the treatment of refractory depression.

More than half of nursing home and assisted living residents have a different form of dementia, and many of these residents experience BPSD (behavioral and psychological symptoms associated with dementia). The preferred therapies for management of these symptoms are non-pharmacologic, including environmental modifications. If an underlying cause or reason for the behaviors can be identified, a non-pharmacologic approach that addresses this underlying cause can be effective and safe.

The American Health Care Association offers a new, three-year quality initiative to help nursing homes and assisted living communities improve person-centered care for their residents. One of the goals of the initiative is to reduce the off-label use of antipsychotics by 15 percent by the end of this year.

The American Society of Consultant Pharmacists has developed a question and answer document on the use of antipsychotic medications in nursing facility residents.

And, CMS offers a webinar, Initiative to Improve Behavioral Health and Reduce the Use of Antipsychotic Medications in Nursing Home Residents. To access go to surveyortraining.cms.hhs.gov/pubs/VideoInformation.aspx?cid=1098 .

When we understand what residents are communicating, we can meet their needs instead of escalating their sense of crisis. Understanding the meaning behind behaviors helps staff build the relationships with residents.

How dementia impacts the behavior of those with moderate dementia:

•Difficulty with short and long term memory.

•Struggles to learn new things.

•Difficulties with understanding and being understood.

•Knows comfort and discomfort.

•Can’t self regulate emotions.

•Often easily upset or frustrated.

•Can become fearful.

•May misinterpret the actions of others.

How dementia impacts the behavior of those with advanced dementia:

•Limited/no short and long-term memory-often lives in the moment.

•Can’t learn new information or pick up new routines.

•Unable to carry on meaningful conversation.

•May appear withdrawn and can have difficulty interacting or responding to surroundings .

In short — what we label as “behavior” in dementia is really a method of communication by the person affected. Our job is to figure that out and respond appropriately.