Non-pharmacological management of agitation in dementia Kathy Fletcher RN DNP GNP-BC FAAN Director Geriatric Nursing Programs Riverside Health System Clinical Assistant Professor of Nursing University of Virginia

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

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)

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

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

Non-pharmacological therapies Standard therapies: Behavioral Reality orientation Validation Reminiscence

Non-pharmacological therapies Alternative /complementary therapies: Art Music Activity Complementary Aroma Bright-light Multisensory approaches Emotion oriented

Non-pharmacological therapies Psychotherapies : Cognitive-behavioral Interpersonal

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

References: Kverno, KS et al (2009). Research on treating neuropsychiatric symptoms of advanced dementia with nonpharmacological strategies, : a systematic literature review. International Psychogeriatrics, 21 5: Douglas, S et al (2004). Nonpharmacological interventions in dementia. Advances in Psychiatric Treatment, 10, Cohen-Mansfield, J et al (2007). Nonpharmacological treatment of agitation: a controlled trial of systematic individualized intervention. Journal of Gerontology, 62A, #8, Kong, EH et al (2009) Nonpharmacological intervention for agitation in dementia: a systematic review and meta-analysis. Aging and mental health, 13, #4, 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,