Non-pharmacological Interventions and Behaviours that Challenge in Dementia: Reflections

Transcription

1 Non-pharmacological Interventions and Behaviours that Challenge in Dementia: Reflections Adrian Lewis, Senior Occupational Therapist, Department of Old Age Psychiatry, HSE Dublin South Central Alzheimer's Society of Ireland Clinicians Roundtable April 9 th 2013

2 Examples of Behaviours that Challenge ( Responsive Behaviours ) Self-care Mislaying Items Misidentifying family members (5-31%) Wandering Anxiety Agitation (50-60%) Aggression (Verbal/Physical) Repetitive Questioning Shadowing Sleep disturbance Unsafe use of appliances Delusional Ideation (0-50%) Auditory Hallucinations Visual Hallucinations (3-50%) Paranoid Ideation Attending new setting (Day Centre, Respite, etc) Disinhibition Depression / Apathy (12-30%) Pacing

3 Use of Person-Occupation Environment Model within Occupational Therapy (OT) Focus on Interaction between Person (Personality, Physical Health, Residual strengths, Degree of Awareness) Occupation (Showering, Dressing, Eating) Environment (Home, Nursing Home) (Importance of Care-giver - Supports available)

4 Reflections (1) Evolving Terminology (e.g. Responsive Behaviours, Behaviours that challenge, Behavioural and Psychological Symptoms of Dementia - BPSD s, etc.) Achieving Balance between Role of Nonpharmacological Interventions in conjunction with Role of Medication. Timing of Response Early Detection and Intervention crucial for well-being of person and care-giver. Importance of Involvement of Person in process

5 Reflections (2) Use of Therapeutic Occupation (Meaningful Activity) - Occupational Profile, Individual vs. Group, Active vs. Passive Activity, Independent vs. Facilitated Activity) Importance of familiar Environmental Set-up Establishing a Structured Routine for Person/Caregivers. Identify potential Triggers (PADL s and IADL s that cause behaviours that challenge Focus on Prevention as well as Intervention

6 Reflections (3) Focus of Intervention Should be to facilitate persons performance of tasks/activities as well as reducing perceived g risky behaviour (E.g. Use of Technology). Care-giver and Staff Education (ASI programmes and leaflets, DSIDC, Support Groups, Individual programmes with relevant health professionals etc. ) Need for Information Handouts to be applied to individual person by parties involved.

7 Reflections (4) Appropriate Level of Assistance Correct Pitch Enabling effective Communication. Relate role of specific Cognitive Difficulties to particular Behaviours That Challenge Importance of Multidisciplinary Team Approach Need for On-going Evaluation of Nonpharmacological Interventions. (Needs changing over time)

8 Examples of Common Interventions Reality Orientation, Reminiscence Therapy, Bright light Therapy Music Therapy, Live Music Aromatherapy Compensation Strategies for Cognitive Deficits Sonas Programme Cognitive Stimulation Therapy (CST) Sensory Evaluation and Design Mindfulness Validation therapy Sensory e.g. Snoezelen, Pet Therapy Stimulus modulation Person-centred bathing Simulated family presence Environmental Modification Modified Anxiety Management Individualised OT Programmes for Person and their Care-givers.

9 Potential Benefits/Limitations of Developing Non-pharmacological Intervention Benefits Possible less medication usage/ impact of side-effects; Increase sense of control for care-giver Which is more cost-effective? Staff, Medication Where service-user will not take medication or are not safe taking it. Where physical Health may prevent use of particular medication Limitations May require time to gain benefits Risk of being too prescriptive. (Uniqueness of each circumstance) Does it requires more staff? Care-givers ability to put into practice? Takes time / coordination to be effective. What if immediate risk? Crisis Management