Lecture Notes: Non-Drug Interventions in Dementia Care

Presenter

• Speaker: Marianne Smith
• Position: Assistant Professor, University of Iowa College of Nursing

Overview

• Focus on non-drug interventions in treating behavioral and psychological symptoms of dementia.
• These interventions are crucial when symptoms persist after addressing antecedents and triggers.
• Non-drug interventions include caregiver approaches, environmental adaptations, and psychosocial interventions.

Case Study: Mrs. Klein

• Background: Admitted to memory care due to overwhelming home care demands on her husband.
• Initial behaviors: Wandering, elopement attempts, resistance to personal care, language deficits.
• Emergent behaviors: Failure to recognize husband, suspiciousness, nighttime wakefulness, restlessness, pacing, daytime napping, distractibility, and refusal to eat leading to weight loss.
• Delirium symptoms attributed to medication toxicity, infection, and dehydration.

Problem-Solving Approach

• Collaboration among family, staff, and primary care provider to identify triggers.
• Post-delirium, Mrs. Klein displayed jealousy and suspiciousness towards her husband, leading to resistance to activities and isolation.
• Key triggers: Time of day, inactivity, and longing for husband.
• Depression and psychotic disorder considered as potential causes.

Depression Assessment

• Tools Used: MDS Staff Assessment of Mood, Cornell Scale for Depression in Dementia (CSDD).
• Results: Mild depression was indicated but not enough to necessitate medication.

Non-Drug Intervention Strategies

• Person-Centered Care: Adjust approaches and environment with husband's input.
• **Key Interventions: **
  • Validation approaches (not challenging misbeliefs)
  • Evening visits by Mr. Klein
  • Use of music, memory books, and familiar items.
  • Scheduled pleasant activities like phone calls and dancing.
• Environmental Changes: Room decorations with familiar items and photos to facilitate positive interactions.

Staff Coordination and Training

• Addressed inconsistencies in staff adherence to intervention approaches.
• Implemented a buddy system for role modeling by experienced staff.
• Conducted training to emphasize not correcting misbeliefs and sharing success stories.

Monitoring and Evaluation

• Regular assessment using the Cornell depression scale and individualized behavioral logs.
• Activity staff developed a coding system to track responses to activities.
• Monitored physical indicators such as weight and fluid intake.

Outcome and Challenges

• Positive changes observed in behaviors with a structured routine of activities.
• Persistent issue with food intake and weight loss, possibly indicating psychosis.

Conclusion

• Highlighted the importance of involving family in decisions about antipsychotic use through shared decision-making.
• Next Topic: Strategies for shared decision-making in antipsychotic use.