Experts Agree: A Person-Centered Approach Key to Managing Dementia-Related Behaviors
Apathy, depression, anxiety, delusions, hallucinations, sexual disinhibition, sleep disturbance, aggression, and other behaviors can be common in people with dementia. Effectively addressing these requires an individualized, case-by-case approach. In What Is Really Needed to Provide Effective, Person-Centered Care for Behavioral Expressions of Dementia?, a study in the November issue of JAMDA, the authors reported on experts’ attempts to determine how to ensure that care addresses each individual’s condition and comorbidities, wishes, preferences, and values.
The Alzheimer’s Association Dementia Care Provider Roundtable, a group of 23 administrative leaders and expert providers in long-term and community-based care settings, met last year to identify change areas and offer person-centered practical solutions to address the unmet needs of people with dementia. The group identified five areas of guidance:
- Having a foundational person-centered culture that permeates every activity within the organization, from language to mentoring to resource allocation.
- Conceptualizing behaviors as expressions and focusing on behavioral support. While the common “disruptive” or “unpleasant” behaviors and responses are often presented as clinical symptoms of a disease, they are better understood as coping and/or communication strategies of individuals whose ability to think, remember, communicate, and control is lost or has changed.
- Identifying antecedents and placing person-centeredness before protocols. An understanding of person-centered care concepts must come first to recognize how routines may be causing a behavioral expression to occur in the first place for each individual.
- Ensuring training that promotes a person-centered culture. The methods by which providers are trained in applying a specific person-centered approach to address dementia-related behaviors can themselves reinforce an organization’s person-centered values. Curricula can be designed such that learners experience the related activities from the perspective of the person living with dementia.
- Valuing implementation flexibility. A rigid, one-size-fits-all approach cannot be considered person-centered and may interfere with the sustainability of a new practice. Translating one-size-fits-all into a person-centered culture might begin with conducting a full review of each patient’s top soothers and stressors.
The authors concluded, “It is hoped that the five areas of guidance promoted in this article, along with progress in research and policy, will ultimately lead to real provision of effective, person-centered care for behavioral expressions of dementia, regardless of the setting in which care is provided.”
This study was conducted by researchers at the Alzheimer’s Association, Chicago, IL; University of North Carolina at Chapel Hill School of Social Work, NC; Brightview Senior Living Center, Baltimore, MD; Home Instead Senior Care, Omaha, NE; HCR ManorCare, Toledo, OH; Brookdale Senior Living, Brentwood, TN; and Senior Star, Tulsa, OK.
JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit www.jamda.com for more information.
About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.