Antipsychotics in dementia: Best Practice Guide
Non-pharmacological treatment of BPSD
Non-pharmacological treatment should be trialled initially before considering drug therapy. Non-pharmacological interventions should be tailored to the individual and the impact carefully monitored. A balance is necessary as excessive stimulation or over-activity may be counterproductive.
Most recommendations are based on best practice guidelines and institutional experience of what has been shown to work. A systematic literature review has provided evidence to support the effectiveness of activity programmes such as music, behaviour therapy and changes to the physical environment.9
Changes in environment can have a positive impact on symptoms of BPSD
People with dementia have memory and cognitive impairment, and problems in the design and configuration of residential facilities can cause or exacerbate restlessness, frustration, anxiety and disorientation. Simple changes in the environment can be beneficial. These include:
- Moderating noise and other levels of stimulation
- Increasing signage and access to toilets
- Ensuring the surroundings are well lit
- Improving time orientation (e.g. prominent calendar/clock)
- Making the environment as “homelike” and reassuring as possible
- Separating non-cognitively impaired residents from people with dementia
- Small scale group living
- Any measure to reduce stress levels
- If possible, consistency of staff and caregivers.
(adapted from SIGN, 2006)
Recreational activities may enhance quality of life and well being
Activities such as art, music, crafts, cooking, games and interaction with pets stimulate the person with dementia to become involved in a meaningful and enjoyable activity. Involvement in recreation may improve communication and self esteem.
Some useful activities for the management of BPSD
- Exercise
- Gardening
- Music
- Art
- Pet therapy
- Walking
- Group activities e.g. singing or craft
- Maintaining routine
Behavior management may improve symptoms of depression
Behaviour management is defined as a structured intervention usually carried out by caregivers under the supervision of a professional with expertise in this area.5 This might involve removing rewards for attention seeking behaviour or giving rewards for increased social activity. Behavioural management, involving pleasant events or problem solving, has been shown to improve symptoms of depression in people with dementia.10
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