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.
• 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.
Factors Causing Dementia Behavioral Symptoms
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
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)
Communication too complex
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)