Dementia Strategy

Dementia Strategy - From existing evidence and clinical experience, researchers at Johns Hopkins University have created 6 non-pharmacological strategies to identify and better manage behavioural problems of patients with dementia.

Behavioural problems, which may include psychiatric symptoms such as depression, psychosis, apathy, agitation, aggression, delusions and hallucinations, as well as a disturbing behavior, like repeating sentences and wandering, are often difficult to manage and can both increase the risk of dangerous activities (walking in traffic, for example) that be extremely stressful for caregivers.
Doctors sometimes prescribe atypical antipsychotics for managing behavioral symptoms.
In an article published in the November 21 issue of JAMA, Laura n. Gitlin, PhD, of the Department of community health of the School of Nursing at Johns Hopkins University in Baltimore, Maryland, and colleagues summarized six non-pharmacological approaches to identify and manage behavioral problems.

The 6 stages

The researchers searched PubMed published studies in peer-reviewed journals between January 1992 and 1 July 2012, and have tried the latest publications by systematic reviews, meta-analyses, Cochrane reviews, and randomized studies of non-pharmacological treatments both at home and in nursing homes.

Dementia Strategy

From this research and by the example of Mr. p., a 93enne with mild cognitive impairment resulting from vascular disease of the brain, who lives with his cousin primary caregivers, researchers have developed 6 key approaches to discover and manage disruptive behaviors:

1. identify the behaviors and implement preventive actions: experts recommend proactive verification of behaviors, using a reliable and validated (for example, the Neuropsychiatric Inventory). Preventive measures may include discussion with caregivers about the importance of self-care, appropriate stimulation, feeding, sleeping, and identification of first symptoms.

2. Describe the behaviors that occur when you develop destructive behaviors or troubling, doctors should make a formal evaluation, a process that involves the interview both the patient and the caregiver. Although physicians should consider behaviors from the perspective of the patient, the caregiver's involvement is essential, especially as the disease progresses. It is important to determine the burden of caregiver, as a depressed caregiver can have benefits via a psychiatrist or counselor.

3. Identify the underlying causes: physicians must try to find possible causes of behaviors, including the contribution of factors relating to the patient as other diseases, pain, or medication. They must observe the style of communication and coping with the situation of caregivers, proximity to the patient, and the level of access to support. You should also assess the home environment in terms of excessive or insufficient stimulation.

4. develop a treatment plan that should aim the behaviors and eliminate the factors scatentanti editable. Simple tasks such as daily walks together can increase feelings of well-being and improve sleep. Social activities and otherwise likes the patient can reduce the shaking. Depression can be reduced with a combination of exercise and caregiver training in behaviour management techniques. The authors cite a randomized clinical study with 272 patients living in the community, and their caregivers that have shown that focusing and changing behaviors, potential triggers, improve or eliminate symptoms and patient wellness and rise of caregiver skills. "The possible strategies, based on the identification of factors contributing to the behavior, could include eliminating caffeinated beverages, afternoon nap, and stimulation by environmental distractions (television at bedtime), and the implementation of a daily routine of exercise, significant activities of a structured routine night possible involvement of background music," the authors write.

5. Determine the effectiveness of non-pharmacological strategies: If there are behavioral improvements, it is important to determine if there have been changes in behavioral characteristics, in the environment of the patient, or the patient's State of health, the authors note. Might also be a good idea to analyze how the caregiver has implemented various strategies.

6. Determine if are emerging new behavioral symptoms: behavioural symptoms and stress of caregiving should be checked on a regular basis, and the control must be continuous, the authors write.

You can read another articles like   Activities For People With Dementia, Dealing With Dementia, Dementia Definition,  Dementia Diagnosis.


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