We suggest that you think of four broad approaches to a treatment plan.
One is a set of what we call generalized approaches to addressing the behavior.
And I'll go into a little bit more detail about this in a moment.
But basically, a generalized approach to using non pharmacologic strategies,
is not addressing any one behavior, but
it's designed to enrich the environment in general, and
to reconnect a person with dementia to their environment and to previous roles.
So in example is for using activity as a way to keep the environment,
the person engaged in a meaningful way to their environment.
Another generalized approach is to improve the caregivers education and
support and skills and their general well being.
So again, this is a generalized approach that is reflective of
good comprehensive dementia care practice that can minimize,
I should say prevent, minimize or reduce behavioral symptoms.
Another approach may be a very targeted approach and
this involves basic problem solving to identify the behavior and
very specific strategies that could eliminate that particular behavior.
So that if the person is scared of getting in and out of a shower for
example, providing a grab bar and
having them hold onto that, may be an approach that's very targeted.
Again, it's to this way of thinking about devising a treatment plan
involves how do characterizing the behavior and
the potential underlying causes and then modifying those specific factors.
It may be, that you use these two different approaches, and
that even then still, referral to a specialist is important and necessary.
And so, always consider that it may be necessary for
certain kinds of behaviors to have the opinion and
expertise of geropsychiatrists, or psychologists, or occupational therapists,
or geriatric nurse who can work with you to solve this kind of behavioral puzzle.
And of course the fourth approach is using a combination of all of these.
So let me get a little bit more specific
of what we mean by general non pharmacologic strategies.
Because these should be introduced as a way to prevent behaviors and
also as a way to manage them and they involved on going support education and
skills training of caregivers.
We have over 20 some years of research,
excellent studies showing through randomized trial design,
a wide range of caregiver support programs that are highly effective.
And we can show also in this research that these approaches to
helping families understand the disease, and providing them with very specific
skills to learn how to communicate effectively, how to use activities, and
how to understand the behaviors are not intentional or done in spite of
the person does it to spite the caregiver, are very effective ways to
not only help the caregiver but actually to reduce the behavioral symptoms.
We also know a very good way of a general non pharmacologic
approach in a very good way of managing and preventing and reducing behaviors, is
helping families set up structured daily routines that are highly predictable.
And here, using calendars and memory boards, and
setting up a structure that the person with dementia can depend on day to day,
is a way of reducing anxiety, aggression, and agitation.