Six Steps to Reduce Dementias Troubling Symptoms

by Teddi Fine

Many of dementia’s behavioral symptoms, such as confusion, repetitive questioning, combativeness, wandering, hallucinations, and loss of inhibition, can be managed well without medications, according to Johns Hopkins University School of Nursing (JHUSON) professor Laura Gitlin, PhD. The key is integrating behavioral management strategies into early, ongoing treatment.

Behavior changes are among the most visible, disruptive, and distressing symptoms of Alzheimer’s disease and other dementias.

Gitlin and her coauthors outline a six-step approach to help clinicians identify and effectively manage most dementia symptoms in “Nonpharmacologic management of behavioral symptoms in dementia” (Journal of the American Medical Association, November 21, 2012).

“This six-step process should be a routine part of regular healthcare for individuals with dementia,” observes Gitlin, who directs the JHUSON Center for Innovative Care in Aging. “It should be undertaken in any clinical setting involved in caring for someone with dementia, including primary care and memory clinics, as well as in hospitals, assisted-living, and nursing facilities.”

Behavior changes are among the most visible, disruptive, and distressing symptoms of Alzheimers disease and other dementias, yet many medications used to treat them carry significant risks and have been found to be relatively ineffective. Gitlins process, in which clinicians provide families and caregivers with simple tools and strategies, can help prevent challenging behavioral symptoms without medication. For example, to reduce a patients confusion and disorientation, a caregiver might be encouraged to break daily activities into small, simple steps and to establish structured routines. Low-tech interventions like these can reduce symptoms and unnecessary health care costs related to urgent visits to hospital emergency departments.

MANAGING WITHOUT MEDS

1 Screen for behavioral symptoms early

2 Identify symptoms

3 Delineate the triggers and risk factors for the symptoms

4 Choose the proper interventions

5 Evaluate the intervention to make sure that its working

6 Follow the patients progress over time