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Non-pharmacological management of agitation in dementia
Kathy Fletcher RN DNP GNP-BC FAANDirector Geriatric Nursing Programs Riverside Health
SystemClinical Assistant Professor of Nursing University of
Virginia
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Objectives
• Discuss the prevalence of neuropsychiatric symptoms in residents with dementia
• Identify the negative outcomes associated with agitation in residents with dementia
• Describe the various nonpharmacological therapies used to address agitated behaviors
• Review the literature on the effectiveness of non-pharmacological therapies to help manage agitation in residents with dementia
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Prevalence of Neuropsychiatric Symptoms (NPS)in individuals with dementia
• 40% of residents with dementia in special care units and nursing homes have severe to very severe cognitive impairment (Gruneir, 2007)
• The majority of residents with severe dementia (50-80%) have one or more NPS—the most common agitation, aggression, psychosis, depression, apathy, withdrawal & aberrant motor behavior (Zuidema, 2007; Kverno, 2008)
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Negative outcomes of agitation in residents with dementia
• Often it is a reason for LTC admission in the first place
• Increased use of psychotropic drugs • Diminished quality of life• Resident/family distress• Caregiver burden
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Best Person-Centered Practice • First determine if the behavior is harmful to the
resident or to others• Second: ABC’s: Antecedents, Behavior,
Consequences• Third determine if the behavioral or psychological
symptoms are the consequence of a physical illness or medications used to treat these
• Fourth try non-pharmacological approaches• Last use drugs in the lowest possible dose for the
shortest period of time
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Non-pharmacological therapies
Standard therapies:
BehavioralReality orientationValidationReminiscence
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Non-pharmacological therapies
Alternative /complementary therapies:ArtMusicActivityComplementaryAromaBright-lightMultisensory approachesEmotion oriented
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Non-pharmacological therapies
Psychotherapies :
Cognitive-behavioralInterpersonal
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Summary
• Person-centered and tailored interventions are most appropriate with non-pharmacological approaches
• The need to work with professionals, families, and the system to address this concern
• Education of the staff to change attitudes and behaviors in intervening with residents demonstrating NPS
• More high level research in this area is needed
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References: • Kverno, KS et al (2009). Research on treating neuropsychiatric symptoms
of advanced dementia with nonpharmacological strategies, 1998-2008: a systematic literature review. International Psychogeriatrics, 21 5:825-843.
• Douglas, S et al (2004). Nonpharmacological interventions in dementia. Advances in Psychiatric Treatment, 10, 171-179.
• Cohen-Mansfield, J et al (2007). Nonpharmacological treatment of agitation: a controlled trial of systematic individualized intervention. Journal of Gerontology, 62A, #8, 908-916.
• Kong, EH et al (2009) Nonpharmacological intervention for agitation in dementia: a systematic review and meta-analysis. Aging and mental health, 13, #4, 512-520.
• Ayalon, L et al (2006). Effectiveness of nonpharmacological interventions for the management of neuropsychiatric symptoms in patients with dementia: a systematic review. Archives of Internal Medicine, 166, 2182-2188.