A baby cries, and we soothe it. But, when our older adult parent suffering from dementia has an outburst, how do we handle that? Sometimes these non-memory-related symptoms such as aggressiveness, agitation, or even delusions, the first treatment plan is to go to antipsychotic medications. But, more often than not, these drugs mask real issues and do not treat the underlying issues that a person with dementia or Alzheimer’s is dealing with daily.
Elder Care Alliance’s fundamental philosophy is that while cognitive skills may diminish, every person can still grow and learn. Our team members are grounded in four basic principles, honoring each resident through dignity, respect, independence, and choice through our engagement-focused memory care program based on the I’m Still Here® philosophy. This approach focuses on addressing irritability, aggression, apathy, and anxiety associated with dementia and Alzheimer’s. Once thought of as untreatable symptoms of Alzheimer’s and related dementias, these behaviors are sometimes treated with medication versus alternatives that get to the heart of the issue.
Non-Pharmacological Approach to Dementia
In the media, people with dementia are typically portrayed as frail, disengaged, and usually shown in a nursing home slumped over in a wheelchair—usually medicated. These images contribute to the “public narrative of despair” about dementia. Dr. John Zeisel is the president and founder of Hearthstone Alzheimer’s Care and the I’m Still Here® Foundation. Both organizations advocate for a more promising approach to addressing and treating those living with dementia. Zeisel says people with the disease can still live a full life. We see it every day in our memory care neighborhoods at our Elder Care Alliance communities.
“They present Alzheimer’s as the end of your brain, the end of your life, the end of your relationships,” he says. Unfortunately, these stereotypes perpetuate a stigma that hinders the perception, awareness, and treatment of dementia.
While medicating older adults who are displaying what is known as the “Four A’s of Alzheimer’s” (Aggression, Agitation, Anxiety, and Apathy) is an easy pacifier for caretakers, According to Zeisel, many memory care communities have found success with activities that foster engagement, like specially designed reading groups or social clubs instead. In addition, Zeisel says art and creative activities have been incredibly effective in reducing symptoms at Hearthstone. One participant in an art program was a former artist with dementia who hadn’t painted for years. He began to paint in the class, and his artwork became more complex as time went on. After a year, he taught other students and eventually ran his own painting class.
Masking the Problem
“Medical Sedation for the convenience of staff members, it is so problematic.”Erin Partridge, Ph.D., ATR-BC, Elder Care Alliance Experiential Researcher is Residence
As Elder Care Alliance’s Experiential Researcher in Residents, Erin Partridge, Ph.D., ATC-BC explains, there are other solutions when residents exhibit behaviors such as aggression. Often these behaviors are the only way the resident can express themselves. We don’t see residents as agitated people, but what we see is that the behavior they are exhibiting is trying to communicate something to us.
“How can I understand what it is that person is trying to communicate and show them I am trying to understand them? How can I find ways if I can’t fix it? What can I do ease some of that or how can we better communicate rather than banging on the exit door or getting agitated with me or another staff person or resident. How can I diffuse the situation in the moment and get creative around how I am approaching this person,” Partridge said.
Antipsychotics and Older Adults
Not to mention antipsychotics aren’t always safe for older adults. Although they are approved to treat serious mental illnesses like schizophrenia and bipolar disorder, the FDA says these drugs can increase the risk of death for people with dementia. Still, a study published by Human Rights Watch found in 2018, about 179,000 senior living residents were being given antipsychotic drugs even though they don’t have schizophrenia or other serious mental illness these drugs are designed to treat. In addition, the study concluded that antipsychotic drugs were often administered without informed consent to make dementia patients easier to handle in understaffed facilities.
These medications now come with a black box warning issued by the FDA. Black box warnings are the most severe warnings the FDA issues. Their purpose is to warn doctors and patients about severe or life-threatening adverse drug reactions. Antipsychotics earned a black box warning because they are associated with increased stroke and death rates in older adults with dementia.
Not to Fear
These drugs are being used less for people with dementia. In 2012, the Centers for Medicare & Medicaid Services and federal and state agencies created a national partnership to reduce the use of antipsychotic drugs in nursing homes in collaboration with the nursing home industry and advocacy organizations. Since then, the use of the drugs has dropped by a third nationwide and has called for an additional 15 percent reduction currently.
Elder Care Alliance and Memory Care
Dementia is a complex disease, but it does not have to be the end of a person’s life. Programs like I’m Still Here®, are creating a new narrative about dementia, one that is centered on hope. By focusing on the strengths and skills that remain, this approach is helping those with dementia lead rich, fulfilling lives.
Learn more about how Elder Care Alliance memory care communities implement the I’m Still Here® philosophy and our non-pharmacological approach to care.