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Using Antipsychotic Medications Cheat Sheet by

medications     healthcare     antipyschotic     behavorial

Introd­uction Person­-Ce­ntered Dementia Care

A person­-ce­ntered care model views things from the perspe­ctive of the dementia patient. Activities and personal approa­che­s/i­nte­rve­ntions are determined and implem­ented based on their relevance to the indivi­dual's specific needs, interests, culture, and backgr­ound. It is important to understand the person's life experi­ences; descri­ptions of known behaviors; prefer­ences such as those for daily routines, food, music, and exercise; oral health; presence of pain; and medical condit­ions.

Learning more about an individual enables personal needs to be antici­pated and identifies person­alized approa­che­s/i­nte­rve­ntions that are the most meaningful and helpful. Unders­tanding a person's needs and typical response to unmet needs promotes person­alized approaches that can be implem­ented more quickly and can often prevent a situation from turning into a catast­rophic event, such as extreme fear, and the need for emergency department and hospital visits. Nonpha­rma­cologic approaches that should be person­alized based on the indivi­dual's prefer­ences and needs with dementia that may include:
Cognitive/emotion-oriented interv­entions (remin­iscence therapy, simulated presence therapy, validation therapy);
Sensory stimul­ation interv­entions (acupu­ncture, aromat­herapy, light therapy, massag­e/t­ouch, music therapy);
Snoezelen multis­ensory stimul­ation or transc­uta­neous electrical nerve stimul­ation;
Behavior management techni­ques; and
Other psycho­social interv­entions such as animal­-as­sisted therapy and exercise

Using Antips­ychotic Medica­tions

1. Target sympto­ms.
• Identify and document specific target symptoms prior to initiation of antips­ychotic medica­tion.
• Discuss the targeted symptoms with the patient and/or approp­riate surrogate decision maker.
2. Consent.
• Obtain and document consent for these medica­tions.
• Discuss the purposes and potential adverse effects of these medica­tions, including FDA warnings regarding antips­ychotic use in dementia.
3. Monitor for effect­iveness and toxici­ty.
• Use the lowest effective dosages, and increase dosages slowly and only if indicated clinic­ally.
• Consider the use of standa­rdized measures of agitation or behavioral symptoms in dementia, such as the Pittsburgh Agitation Scale or Cohen-­Man­sfield Agitation Inventory.
4. Consider tapering and discon­tinuing these medica­tions when the target symptoms remit.
• While there is a risk of sympto­matic relapse, evidence indicates that these medica­tions may often be tapered without adverse clinical events, partic­ularly if the symptoms were not severe.
5. Monitor patients for evidence of relapse if and when the medication is decrea­sed­/di­sco­nti­nued.
 

Patient Centered Care

Factors Causing Dementia Behavioral Symptoms

Pers­on-­Based
Care­giv­er-­Based
Envi­ron­men­tal
Lack of daily routines
Commun­ica­tions too complex
Room arrang­ements (clutter)
Sensory deficits (eg, hearing, vision)
Harsh emotional tone
Lack of approp­riate visual cues
Physical needs (eg, hydration, consti­pation, body temper­ature)
Caregiving styles conflict with dementia patient
Physical and/or social stimul­ation (too much or too little)
Intere­sts­/pr­efe­rences not met
Family care respon­sib­ilities
Too hot or too cold
Level of stimul­ation not approp­riate
Financial situation
Safety risk
Health issues (eg, infection, consti­pation)
Caregiver distre­ss/­health issues
Needed items are out of sight or not where the person can see them
Impact of other illnesses or conditions
Poor relati­onship with dementia patient
Lack of needed adaptive equipment (eg, grab bars in bathroom)
Ambulation and/or difficulty finding one’s way (getting lost)
Lack of availa­bility (staffing issues)
Poor lighting
Medication changes
Commun­ication too complex
Pain
Insuff­icient training
Challenges performing activities of daily living (eg, bathing, dressing, using toilet, grooming, eating)
Lack of supportive network or system within facility for dementia care
Sleep cycle disrup­tions
Limited opport­unities for respite
Emotional status (eg, insecu­rity, sadness, anxiety, loneli­ness)

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