“The squeaky wheel gets the oil” is a well-known proverb. In terms of challenging behaviors, the man running down the hall naked or the woman crying loudly at lunch generally get our attention more quickly than the quiet lady in room 101 who likes to keep to herself and “isn’t any trouble.”
In fact, all of these behaviors are in need of our attention, including the lady in room 101. Apathy is one of the most common and persistent of the behavioral and psychologic symptoms of dementia, and has profound consequences for morbidity and mortality. While research shows that apathy is associated with changes in brain function in people with neurodegenerative disease, it also shows that individual, caregiver and environmental factors also precipitate apathy.
Non-pharmacologic approaches to apathy have shown to be more effective (pharmacologic approaches have shown modest results), with tailored activities based on the person’s history, preferences and retained abilities. These person-centered activities can supply intrinsic motivation by capturing the interest of the person and providing them with a reward. Music therapy, multi-sensory behavioral therapy, art therapy, cognitive stimulation, and therapeutic conversation are some interventions to try.
We invite you (CONTEST ALERT!) to send us a tidbit about how you manage residents with apathy at your community. Did something specific you did work for a resident? What are some of your creative ideas for how to approach apathy? The communities that send us the best tidbits will win prizes! Please email them to firstname.lastname@example.org.
Have a great week!
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!
IPA complete guide to BPSD: Non-Pharmacological treatments