When someone has Alzheimer’s or dementia, doctors prescribe calming drugs to control behaviour. Now, a study proves that non-drug approaches should be the first choice for treating dementia patients’ common symptoms such as irritability, agitation, depression, anxiety, sleep problems, aggression, apathy and delusions, say the researchers in a paper just published by the British Medical Journal.
The focus then, should be on training the caregivers — spouses, adult children or staff in nursing homes and assisted living facilities — to make behavioral and environmental interventions instead of making patients become listless via drugs.
“The evidence for non-pharmaceutical approaches to the behavior problems often seen in dementia is better than the evidence for antipsychotics, and far better than for other classes of medication,” says first author Helen C. Kales, M.D., head of the U-M Program for Positive Aging at the University of Michigan Health System and investigator at the VA Center for Clinical Management Research. “The issue and the challenge is that our health care system has not incentivized training in alternatives to drug use, and there is little to no reimbursement for caregiver-based methods.”
It is so much easier to prescribe drugs hence caregivers and doctors have been taking the easy way out and has led to the overuse of anti-psychotic drugs. Now, there needs to be a shift of resources from paying for psychoactive drugs and emergency room and hospital stays to adopting a more proactive approach. Antidepressants make sense for dementia patients with severe depression, and antipsychotic drugs should be used when patients have psychosis or aggression that could lead them to harm themselves or others. But these uses should be closely monitored and ended as soon as possible. Many “hidden” medical issues in dementia patients — such as urinary tract infection and other infections, constipation, dehydration and pain — can lead to behavioral issues, as can drug interactions. So physicians should look to assess and address these wherever possible.
Researchers give tips that are designed to prevent or mitigate triggers for common symptoms such as pacing, repetitive questioning, restlessness, or shadowing. For instance, de-cluttering the environment, using music or simple activities that help to engage a person with dementia , or using a calm voice instead of being confrontational, could help greatly to reduce behavioral symptoms. And making sure that caregivers get breaks from their responsibilities and take care of themselves, especially in the home, can help them avoid burnout and taking their frustration out on patients.