Last week we discussed some of the negative side effects of psychotropic drugs commonly used to treat behavioral and psychological symptoms of dementia (BPSD) and a 5-step approach to reduce their use. The next step is to explore alternatives to pharmacologic treatment to decrease these challenging behaviors. Educating staff and loved ones of residents about these alternatives is critical to successfully addressing BPSD for the long term.
According to the IPA Complete Guides to BPSD , a large body of evidence supports the use of psychosocial interventions for BPSD and these approaches are indicated as first-line management. These interventions work best when they are tailored to people’s backgrounds, interests and capacity. See the PELI Tools.
Treatment Principles for BPSD (from the IPA Complete Guides to BPSD, Module 5):
- Address one symptom at a time
- Follow the ABC approach: Specify the Antecedent of Behaviors (circumstances that spark them) and their Consequences (what makes them better or worse)
- Measure the symptom before an after making an intervention to confirm that it is effective
- Start with a small achievable goal and proceed step by step
- Apply the intervention consistently. Do not expect immediate change; improvement takes time
- Continually evaluate and modify plans. Decide in advance what “success” means for this person
- Think in advance of an alternative strategy if this one fails
Researchers continue to conduct a variety of studies to determine the effectiveness of non-pharm treatments including: activity and recreation, aromatherapy, family tape-recordings, music and sound, one-to-one interaction and physical activity.
Attached is a pdf file with Module 5 of the IPA Guide to BPSD, which includes much more information on non-pharmacological treatments. Since these approaches need to be feasible in addition to being effective, the Nursing Home Toolkit includes practical guidance for nursing home providers who are trying to integrate non-pharmacological approaches to address BPSD.
Have a great week!