Improving Dementia Care Through Behavioral Interventions

Abstract

Behavioral interventions are effective in treating neuropsychiatric symptoms of dementia, yet older adults with dementia who require long-term care lack consistent access to caregivers who are skillful in selecting and applying these interventions. This commentary describes national and state-level initiatives that can improve access to effective behavioral techniques.T he devastating effects of major neurocognitive disorders such as Alzheimer's disease, vascular dementia, Lewy body dementia, and frontotemporal dementia are well recognized, particularly the challenges presented by the neuropsychiatric symptoms (NPS) of such disorders [1]. A growing body of scientific evidence shows that behavioral treatment for NPS is effective for patients with dementia and that behavioral approaches can reduce the severity and frequency of caregiving challenges [2]. Although there is no cure for dementia, the lives of patients and their caregivers can be improved through more widespread and systematic implementation of behavioral approaches for managing NPS or other dementia-related challenging behaviors. Moreover, passage of the National Alzheimer's Project Act [3] in 2011 has focused more attention on dementia at the federal, state, and local levels, which has galvanized efforts to strengthen research, workforce development, and long-term care services that can improve the lives of those affected by dementia [4,5]. The purposes of this commentary are to offer a brief review of the core features of behavioral approaches for the management of NPS in patients with dementia and to discuss promising practices for implementation across the long-term care spectrum.According to the North Carolina Department of Aging and Adult Services, Alzheimer's disease is estimated to affect approximately 170,000 North Carolinians, and by 2030 that number is projected to rise to 300,000 [6]. Approximately 30% of affected individuals currently receive care in residential long-term care facilities, including both assisted living facilities and skilled nursing facilities [6]. One of the greatest challenges in caring for patients with dementia is dealing with NPS. These symptoms are highly prevalent, affecting almost all patients with dementia at some point during the course of their illness [1]. Dementiarelated NPS can be categorized as behavioral excesses (eg, agitation, aggressiveness, repetitive vocalizations, or pacing) or behavioral deficits (eg, withdrawal, apathy, or failure to initiate or engage in self-care or social activities); alternatively, they can be classified as behaviors that are dangerous (threatening caregivers or striking out) or as behaviors that annoy others but are not dangerous (hoarding or repetitive behaviors) [7].Historically, antipsychotic and sedative medications were used to help manage dementia-related NPS; however, these uses are not approved by the US Food and Drug Administration (FDA). Importantly, studies over the past decade have demonstrated that antipsychotic medications have limited efficacy when used for this...

Depression in the Family of Patients With Dementia in Korea

“…4 No cure for dementia currently exists, and the number of individuals with AD and other types of dementia continues to grow. 5 The home-based care of individuals with dementia is an important topic to address. The burden on caregivers is known to be higher among those who care for a patient with dementia compared to those who care for patients with other medical illnesses.…”

Long-Term Care in North Carolina

“…Interventions include adjusting the caregiver's interaction with the patient, modifying the environment, and utilizing behavior-specific interventions. The commentary by McConnell [16] outlines the components of behavioral interventions that can be used to guide implementation of these evidence-based practices.…”