Patients with dementia are often unnecessarily treated with strong anti-psychotic medications or traumatized by being forcibly restrained and transported to a psychiatric facility.
A University of Wisconsin-Milwaukee nursing professor told a congressional forum last week that there are better options nursing homes could and should use with patients with Alzheimer’s disease and other types of dementia.
Professor Christine Kovach’s research focuses on caring for such patients, who are often unable to clearly communicate the causes of their behavior. She was among a panel of experts presenting information to the U.S. Senate Special Committee on Aging Forum on Dec. 8. The forum, “Until There’s a Cure: How to Help Alzheimer’s Patients and Families NOW” was led by Wisconsin Sen. Herb Kohl.
In her research, Kovach has been working with 14 local nursing homes to train nursing staff to better manage pain, infection, agitation and other issues that may cause dementia patients to become agitated and/or aggressive. The nursing homes use a protocol Kovach developed called the Serial Trial Intervention to assess and treat the symptoms dementia patients exhibit.
Kovach shared several examples from her research of inappropriate use of strong psychotropic medications with dementia patients who couldn’t clearly communicate the causes of their pain. In one case, a woman with dementia began to shout out, “No, no” when nursing home staff approached her. The woman was initially treated with a psychotropic drug for paranoia. Twenty-seven days after the behavior change started, home staff noticed that she had trouble moving her leg. An X-ray showed she had fractured her hip. The anxiety and shouting were her only way of communicating something was wrong.
In another case, a man with dementia became agitated and complained his legs were burning and itching. When nurses in the research clinical trial assessed him, they discovered his symptoms were caused by neuropathic pain in the legs, and were easily treated with medications for the condition. His behavior immediately improved.
Training nursing home staff in the use of research-validated interventions such as the Serial Trial Intervention could help improve patient care and reduce the need to move severely agitated patients to acute general or psychiatric hospitals, Kovach told the forum.
Her presentation noted that Milwaukee police were called to nursing homes 386 times in a six-month period, many times to respond to resident behavior issues. Often, dementia patients needed to be forcibly restrained for transport to psychiatric facilities, further traumatizing them.
In addition to developing better ways of assessing the needs of dementia patients, nursing home culture and environmental design need to be transformed, Kovach told the forum. “Many nursing homes were initially designed based on a medical model for care delivery with long corridors, an institutional scale and rigid schedules for activities.” With the decreased opportunity for moving around safely, patients may develop muscle atrophy, have to use wheelchairs or develop pressure sores. The lack of control over daily activities also takes a toll on the patients socially and psychologically.
One solution Kovach recommended was the development of more home-like settings that allow patients and families more control over daily activities – smaller dining areas, living rooms and space for activities and exercise.
Training nursing home staff in assessments like the Serial Trial Intervention and improving the nursing home environment are cost-effective ways of addressing the needs of Alzheimer’s and other dementia patients, Kovach told the forum. Common pain relievers like Tylenol are often more appropriate and less expensive than psychotropic drugs and have fewer side-effects. And, she added, often the assessments find that patients can be treated with no drugs at all.
“It is common for us to find the person has too many environmental stressors, is not receiving enough exercise, is bored or is not receiving enough meaningful human interaction,” said Kovach. “These needs are easily met with inexpensive nonpharmacological interventions that have no side effects.”