Transcript No Slide Title

Non-medication Management of
Agitated Behavior in Dementia
Patients
Josepha A. Cheong, MD
University of Florida Departments of Psychiatry and
Neurology
Chief, Division of Geriatric Psychiatry
Current Prevalence of AD
• AD is the fourth leading cause of death due to disease
for people > 65 years of age in the United States1
• Approximately 4 million people in the United States
have AD2
• AD is a progressive, neurodegenerative disease
involving:
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Loss of memory and other cognitive functions
Decline in ability to perform activities of daily living
Changes in personality and behavior
Increases in resource utilization
Eventual nursing home placement
1. Murphy SL. Natl Vital Stat Rep. 2000;48:1-106.
2. Evans DA. Milbank Q. 1990;68:267-289.
Irreversible dementias (%)
AD Is the Most Prevalent Type of
Irreversible Dementia
100
80
60
40
20
0
AD
VaD
DLB
FTD
Other
VaD, vascular dementia;
DLB, dementia with Lewy bodies;
FTD, frontotemporal dementia.
, reflects difficulties diagnosing/
Guttman R et al. Arch Fam Med. 1999;8:347-353.
reporting dementias; only estimations McKeith IG et al. Neurology. 1996;47:1113-1124.
of prevalence can be made.
Cherrier MM et al. J Am Geriatr Soc. 1997;45:579-583.
Disease Progression in
Alzheimer’s Disease
100%
Cognitive ability
Functional ability
Change in
disease
progression
Behavioral problems
Caregiver time
0
1
2
3
4
5
6
Years from diagnosis
7
8
9
0%
What is Agitated Behavior?
• Non-cognitive symptom of dementia
(cognitive = memory loss, language
difficulty)
• 2 types of non-cognitive symptoms:
– Psychiatric
– Behavioral
Psychiatric Symptoms
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•
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Personality changes
Depression
Hallucinations
Paranoia
Misidentifications
Mania
» Alzheimer’s Disease International Factsheet
Behavioral Disturbances
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•
•
•
•
•
•
Aggression
Agitation
Wandering
Sexual disinhibition
Incontinence
Increased eating
Screaming
20-30%
>80%
25 - 50%
10%
50-60%
5-10%
5%
Modified – Alzheimer’s Disease International Factsheet
Why Manage These Symptoms?
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•
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Caregiver stress and burden
Stress on the patient
Precipitant of nursing home placement
Very manageable with non-medication and
medication treatment
Why Non-medication
Management?
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Less restrictive
Effective in early dementia
Fewer complications
Stresses the importance of family and nonmedical caregivers
General Principle
How would I deal with this
problem behavior if this person
were a 3-5 year old child?
Assessment
• Rule out any environmental disturbance
– change in home setting
– change in the staff/family members
– death of a pet
• R/o any possible medical illness
– urinary tract infection
– dehydration
Assessment
• R/o drug-drug interactions or drug
intolerance
• When does the behavior occur
– constant regardless of stimuli
– specific time of day
– with caregiving activity
Assessment
• Endocrine
• Iatrogenic - consider non-prescription
medications
• Injury
• Intoxication
Treatment
• Behavioral Intervention
– redirection
– no-fail environment
• adjusting the environment to meet the needs and the
limitations of the patient
– structure and consistency
– avoid overstimulation
Specific Problems
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Wandering
>50% of AD pts wander
86% are located w/in 5 miles of home
37% are found w/in 1 mile of home
14% are found > 5 miles from home
2002 – Meredith Rowe – UF College of Nursing,
Institute of Aging
Wandering
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Planned activities to counteract boredom
Reassurances
Redirection
Red STOP sign
Disguise the door
Wandering
Safety
• Appropriate identification
• Bright vest
Wandering
Alzheimer’s Association Safe Return
• Education
• National photo/info database
• 24 hour toll-free emergency crisis line
– 1-888-572-8566
– 1-800-272-3900
– www.alz.org
Baker Act - 52/32
• 52 - involuntary evaluation
• 32 - involuntary committment
Referral
Shands at UF
Inpatient Geriatric Psychiatry Unit
Intake Coordinator 352-265-5411
GO
GATORS!