Changing Behaviors is Recommended for Improving Dementia

My other half and I recently spent the weekend with a friend and his ailing 79-year-old mother whom he has been caring for since his father died two years ago. It hasn’t been easy for Jay.

His mother started showing signs of dementia shortly after her husband’s death. She’d forget medication, repeatedly tell him the same thing over and over as if it was new again and her house started to become untidy. She repeatedly refused help and became aggressive when offered it. She ignored change and slipped slowly into past mentally and emotionally.

During one of his mother’s medical visits, Jay spoke to her doctor about how her dementia was having an affect on her quality of life and what could be done. Instinctively, the doctor recommended medication.

For most clinicians, this is the first tactic used to treat dementia patients. While medicating a patient has proven benefits and improved results, medication isn’t the magic pill solution. Jay discovered that the real solution involved addressing the physical, mental and emotional health of his mother.

The On-Demand Learning six-part Web series, “Dementia and Antipsychotics in the Long Term Care (LTC) Setting: A Quality Improvement Initiative”, explores the various aspects of dementia, the use of antipsychotic drugs and behavioral issues that arise as a person’s cognitive skills begin to fade. The series is a collaborative effort between Vanderbilt University Medical Center, Vanderbilt University Center for Quality Aging and Qsource.

In “Session 3: Psychopharmacology in the LTC Setting”, Dr. Warren Taylor addresses the pharmacologic intervention and provides insight into how polytherapy can affect patients with dementia. Taylor works for Vanderbilt University in Memphis, Tenn. as the Director of Mood Disorder Program Psychiatry Department.

His presentation touches on the side effects, risks and strategies for discontinuation of common drugs used in LTC settings to treat patients with dementia. He also focuses on how to address behavioral problems in other ways that supplement medication management.

Like Jay’s mother, a patient’s environment is affected by their dementia. People with dementia may hoard food or other items to make them feel in control and safe. They may forget to turn off the oven or where they hid a favorite item. Taylor recommends instituting environmental modifications first to identify what may be in place where they live that is causing them to behave abnormally.

The next step calls for caregivers to examine their own behavior and habits and make modifications that can help a person with dementia. Taylor points out that patients are people with routines, habits and quirks that don’t always mesh with clinical guidelines and schedules. Jay understands this firsthand as he has learned that having a job that calls him away for long hours at a time can wreck havoc on his mother’s eating and medication schedule. So now he prepares meals and pill dosages in advance to meet her daily routine and arranges for in-house care visits when he isn’t available.

If a patient’s behavior can improve by modifying their environment and accommodating routines, Taylor recommends that pharmacological interventions should be considered as the last step in treatment — not the first.

For Jay and his mother, these three steps have resulted in a more controlled and normal living situation. His mother actively engages in conversations with neighbors, maintains a regular sleeping and eating schedule and her medication is closely monitored. The only thing left to do now, according to Jay’s mother, is to get him married off and out of her hair.

 

Lynn Maples,  Marketing/Communications Specialist

Lynn is a multiple award-winning marketing/communications professional and former journalist. He has spent more than a decade sharing patient and provider stories on behalf of the Quality Improvement Organization community.