Non-pharmacological management of Psychiatric and Behavioral Symptoms in the Elderly with Dementia

By CareerSmart Learning Contributor, September 17, 2015, as published by Healthcare Hot Spot



Elderly with dementia exhibit more than just confusion and memory loss; it also impairs their language, attention span, reasoning, behavior and judgment.

In dementia, brain cells atrophy (waste away) and die. Not all parts of the brain, however, may be affected. Because different parts of the brain control different areas of functioning (for example, language, judgment, or concentration), how dementia manifests between individuals can vary widely.

Another facet of dementia: psychiatric disturbances that affect behavior
This group of non-cognitive behavioral and psychological symptoms of dementia (BPSD) accounts for 90% of individuals with dementia (Cerejeria, Frontiers in Neurology, 2012). It disturbs their thought content, mood, perception and behavior. As the brain changes over time due to dementia, the individual may begin to show other effects. Some of these may include:

    • Agitation: a kind of aggravated and irritable restlessness that may include impulsive acts.
    • Perseveration: repeating the same word, response, or action.
    • Delusions: a belief that is firmly maintained despite being contradicted by what is generally accepted as reality or rational argument.
    • Paranoia: fear or distrust of others; may lead to aggression and agitation.
    • Disinhibition: the lack of restraint manifested in disregard for social convention, impulsivity, and poor risk assessment. An example of a disinhibited instinctual drive is hyper-sexuality, whereby increases in sexual urges and thoughts are the result of diminished brain cells and impaired judgment.

Keeping all patients safe
All of the above issues require certain interventions to safeguard the patient from his/herself and keep other patients, staff, and visitors protected as well. Non-pharmacological treatment plans should be the first choice of management and the plan of care should be evaluated frequently as conditions change. In addition, include:

    • More frequent checks and consistent monitoring and documenting of interventions and outcomes
    • Possibly placing the patient in a more secured environment for safety and stimulus control
    • A predetermined, individualized plan to respond to the patient’s behavior, with documentation and discussion with all staff regarding personalized interventions
    • Ongoing collaboration with the healthcare team to monitor symptoms and medications. Psychotropic medications are known to have potentially serious if not lethal side effects in the elderly with dementia, so care teams must carefully evaluate both pharmacological and non-pharmacological treatments.
    • Constant assessment of patient status. Since deterioration can be very slow or sudden, any changes in personality or character should be taken seriously and monitored.
    • Support , guidance and education for the family and caregivers learning to deal with changes in the patient

No matter what the setting, recognizing and addressing psychiatric symptoms at an early state, as well as the behavioral issues that stem from them, is the best way to keep the patient and others safe.

CareerSmart® Learning is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Reference
J. Cerejeira, L. Lagarto, and E. B. Mukaetova-Ladinska. Frontiers in Neurology: Behavioral and Psychological Symptoms of Dementia. Feb. 24, 2012. Retrieved on 9/15/15 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3345875/

September 17, 2015

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