WASHINGTON — Although promising, experimental treatments for dementia are currently in development, a cure is still many years away. In the meantime, developing evidence-based nonpharmacological approaches to disease management is an important public health goal.
“More effort is needed to test and implement behavioral interventions that can help caregivers manage patients with dementia and improve quality of life for them and their families,” said Laura N. Gitlin, PhD, the director for the Center for Innovative Care in Aging at Johns Hopkins University in Baltimore, Maryland, at the 2015 Alzheimer’s Association International Conference.
She suggested that the medical community look at dementia care through the same lens that rehabilitation has traditionally been viewed — as a way to enable people with dementia to achieve their optimal level of function, to help them cope with the disease, and to continue participating in everyday activities for as long as possible.
“This clinical population can positively respond to traditional rehabilitative techniques to address acute functional issues as well as habilitative approaches that are designed to support daily function and quality of life throughout the course of the disease,” Gitlin said.
Effective behavioral interventions include cognitive therapies, exercise, activity engagement in pleasant events, caregiver training, touch and sensory-based strategies, environmental redesign, and music therapy.
But existing research on these nonpharmacological treatments in dementia management is limited by small sample size, a narrow focus on patient populations consisting of nursing home residents, and lack of methodological rigor.
In addition to urging researchers to conduct more and better studies in this area, Gitlin emphasized that for effective engagement to occur, activities must be tailored to a particular patient’s preserved capabilities and interests and should be based on systematic assessment.
She offered several tips to implement a behavioral interventions for patients with dementia effectively:
- Use problem solving to identify modifiable factors contributing to behavioral disturbances or excess disability
- View treatment in context — have an understanding of the person and their environment
- Use effective communication strategies
- Provide a supportive and simplified environment in which new learning and tasks occur
- Use simplified strategies (communication, environment, or tasks) to allow for engagement or enhanced information processing on the part of the dementia patient
- Offer caregiver education, support, and training
“As we think about how to juggle time, energy and funds, we need to find a better balance between cure, prevention, and care, and the best way to implement science so that it benefits patients and their families,” Gitlin said.