Non-Pharmacological Treatment Considerations: A Balanced Decision

Mary Ann Boyd, School of Nursing, School of Nursing, Southern Illinois University, Columbia, IL, USA

In elderly patients suffering from dementia, some of the most disturbing behavioral and psychological symptoms include physical and verbal aggression, wandering, agitation, sexual disinhibition, delusions, hallucinations, misidentification of people and places, depression, anxiety, and disturbed sleep. These symptoms not only contribute to patient morbidity and mortality but also impact on caregivers, causing caregiver burden and depression. It is the behavioral and psychiatric symptoms that are often an important predictor of patient institutionalization.

Management of these problems is paramount to improving the quality of life for both dementia patients and their caregivers. Treatment should be tailored to the individual, and can consist of a combination of pharmacological and non-pharmacological approaches.

Non-pharmacological approaches can be targeted at both patient and caregiver. Of those aimed at patients, approaches such as frequent participation in cognitive activities, hypnotherapy, social skills training, biofeedback, and light therapy have been reported to provide benefit. Cognitive stimulation has been reported to not only reduce the risk of developing Alzheimer’s disease, but also to reduce the decline in cognitive impairment after the disease has been diagnosed. Such interventions also help to reduce caregiver anxiety. Caregiver-orientated interventions include counseling, education, and social support.

Possible pharmacological treatments discussed in this presentation include antidepressants, anxiolytics, mood stabilizers and conventional antipsychotics. However, limited evidence of efficacy and the range of side effects associated with some of these drugs often limit their use in elderly patients.