How Can We Reduce Drugs in Dementia Care?
There is a national initiative to reduce the amount of anti-psychotic drugs used in care homes for dementia residents. This is important because the use of these drugs is hugely expensive for our country and it can adversely impact the quality of life for these residents.
The Center for Medicare Services (CMS), the organization that implements Medicare, is changing policy with a goal of reducing the use of antipsychotic medications by 30 percent for “long-stay nursing home residents” by the end of 2016. Another reason for reducing the use of anti-psychotic drugs in memory care is the recognition that many of the behaviors that they address are a form of unmet communication.
CMS - Asks an Important Question
“Is evidence present that supports activities are implemented for the resident that are based on information gathered during the admission process (i.e., based on known hobbies, routines and life patterns)?”
As part of a Focused Dementia Care Survey Pilot by CMS, states assess how care homes are using personal information gathered by observation, interviews and record reviews. In part, it is an effort to understand if person-centered care is being provided to dementia residents.
Person-centered care is important, especially when dementia residents can’t always articulate their desires. Person-centered care means understanding the person behind the disease - taking into account specifics such as life patterns, likes and dislikes, cultural and religious background, hobbies, occupation and the like. Providing person-centered care helps reduce behavioral and psychological symptoms of dementia (BPSD) and therefore reduce the need for medication.
Non-pharmacological Approaches to Dementia
Common non-pharmacological approaches to dementia often include sensory engagement activities such as art therapy, music therapy and individualized playlists, or social engagement including reminiscing with photos or videos. These activities may require raw materials (art supplies), specialized people (therapists), or the right environment (socializing). However, today there are technology enabled alternatives to make these activities more accessible and compelling.
I was recently involved in implementing a grant that paired university students with residents of a skilled health care facility. The students are using iPads to provide a personalized, non-pharmacological engagement, including activities such as watching YouTube videos, listening to music, reminiscing with images, socializing with remote family and playing games.
Students get to know residents through background provided by the community. Residents and students meet to engage in app activities relevant to the resident’s background. Students help create a Digital Memory Box for their partners, which includes links to favorite music playlists, photo albums, YouTube videos and apps. After the project is complete and the students are no longer visiting, staff can use to these digital memory boxes to engage residents in a personally meaningful way.
Personal Technology in Care Plans
Right now, finding just the right non-pharmacological approach for people with dementia is more of an art than a science. But with experience, non-drug treatments can be both safer and more effective than drugs with the added bonus that these approaches positively impact caregivers as well.
Is it becoming time to employ a care plan that uses personal technology as a non-pharmacological intervention? Yes, I believe it is.