Non-pharmacological management
of agitation in dementia
Kathy Fletcher RN DNP GNP-BC FAAN
Director Geriatric Nursing Programs Riverside Health
System
Clinical Assistant Professor of Nursing University of
Virginia
Objectives
• Discuss the prevalence of neuropsychiatric
symptoms in residents with dementia
• Identify the negative outcomes associated
with agitation in residents with dementia
• Describe the various nonpharmacological
therapies used to address agitated behaviors
• Review the literature on the effectiveness of
non-pharmacological therapies to help
manage agitation in residents with dementia
Prevalence of Neuropsychiatric Symptoms
(NPS)in individuals with dementia
• 40% of residents with dementia in special care units and
nursing homes have severe to very severe cognitive
impairment (Gruneir, 2007)
• The majority of residents with severe dementia (50-80%) have
one or more NPS—the most common agitation, aggression,
psychosis, depression, apathy, withdrawal & aberrant motor
behavior (Zuidema, 2007; Kverno, 2008)
Negative outcomes of agitation in
residents with dementia
• Often it is a reason for LTC admission in the
first place
• Increased use of psychotropic drugs
• Diminished quality of life
• Resident/family distress
• Caregiver burden
Best Person-Centered Practice
• First determine if the behavior is harmful to the
resident or to others
• Second: ABC’s: Antecedents, Behavior,
Consequences
• Third determine if the behavioral or psychological
symptoms are the consequence of a physical
illness or medications used to treat these
• Fourth try non-pharmacological approaches
• Last use drugs in the lowest possible dose for the
shortest period of time
Non-pharmacological therapies
Standard therapies:
Behavioral
Reality orientation
Validation
Reminiscence
Non-pharmacological therapies
Alternative /complementary therapies:
Art
Music
Activity
Complementary
Aroma
Bright-light
Multisensory approaches
Emotion oriented
Non-pharmacological therapies
Psychotherapies :
Cognitive-behavioral
Interpersonal
Summary
• Person-centered and tailored interventions
are most appropriate with nonpharmacological approaches
• The need to work with professionals, families,
and the system to address this concern
• Education of the staff to change attitudes and
behaviors in intervening with residents
demonstrating NPS
• More high level research in this area is needed
References:
• Kverno, KS et al (2009). Research on treating neuropsychiatric symptoms
of advanced dementia with nonpharmacological strategies, 1998-2008: a
systematic literature review. International Psychogeriatrics, 21 5:825-843.
• Douglas, S et al (2004). Nonpharmacological interventions in dementia.
Advances in Psychiatric Treatment, 10, 171-179.
• Cohen-Mansfield, J et al (2007). Nonpharmacological treatment of
agitation: a controlled trial of systematic individualized intervention.
Journal of Gerontology, 62A, #8, 908-916.
• Kong, EH et al (2009) Nonpharmacological intervention for agitation in
dementia: a systematic review and meta-analysis. Aging and mental
health, 13, #4, 512-520.
• Ayalon, L et al (2006). Effectiveness of nonpharmacological interventions
for the management of neuropsychiatric symptoms in patients with
dementia: a systematic review. Archives of Internal Medicine, 166, 21822188.