Antipsychotics Continue to Have a Place in the Management of Difficult Behavior Problems in Patients With Dementia

Jennings, Leigh; Grossberg, George T.

doi:10.1016/j.jamda.2013.03.015

Cited by 10 publications

(1 citation statement)

References 15 publications

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“…31 Another indication for use of antipsychotics is a presence of delusions or hallucinations that are bothersome to the person with dementia, and may be dangerous to the person or others. Many antipsychotics are effective in reducing behavioral symptoms of dementia 32 but their use should be limited because of serious side effects including increased mortality 33 and sudden cardiac death.…”

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Importance of Context in Management of Behavioral Symptoms of Dementia

Volicer

2017

MOJGG

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Submit Manuscript | http://medcraveonline.com symptoms to manage and are often a reason for institutionalization. Development of effective management strategies is hindered by confusing terminology. Research investigating treatments often use "agitation" or "behavioral and psychological symptoms of dementia (BPSD)" as an outcome measure without differentiating the context in which these behaviors occurred. Actually, a recent review of 85 measures, used for assessing behavioral symptoms of dementia, found that "no measures identify risk factors for behaviors or enable an evaluation of the context in which behaviors occur".1 At the same time, it is recognized that there is a need for identification of context in which behavior occurred for effective management as is described in the DICE approach. 2,3The most important context in which behavior occurs is presence or absence of another person. This context can distinguish two main types of behaviors: agitation and rejection of care.4 Agitation can be defined as "behaviors that communicate to others [who observe the patient] that the patient is experiencing and unpleasant state of excitement and which remain after interventions to reduce internal or external stimuli have been carried out". 5 i.e., medical conditions, pain, medication side-effects, environmental factors, hunger or thirst, and others. Symptoms of agitation include general restlessness, repetitive mannerisms, pacing, trying to get to a different place, handling inappropriately, hiding things, inappropriate dressing and undressing and repetitive sentences.6 Agitation occurs when the person with dementia does not interact with others, i.e., is solitary.Rejection of care occurs in most cases when a caregiver tries to provide care for a person who does not understand the need for it, or misperceives the action as threatening, and resists caregiver's actions.7 If the caregiver insists to provide care, the person with dementia may defend himself/herself from unwanted attention, may become combative and develop reactive aggression. This reactive aggression can be defined as "the repertoire of behaviors with which persons with dementia withstand of oppose the efforts of a caregiver". 8 and includes hitting, pushing, scratching, grabbing things or people, kicking and biting, screaming, cursing, temper outbursts, and making strange noises. The main difference between agitation and aggression is that agitation occurs when the person does not interact with others, while reactive aggression occurs during such interactions. This difference is supported by the Minimum Data Set 3.0 evaluations that distinguishes behavioral symptoms not directed towards others, and physical and verbal behavioral symptoms directed towards others.9 Rejection of care is not only stressful for nursing aids as is described in an excellent article by Morgan et al 10 but also for informal caregivers of persons with dementia living at home. 11It is important to distinguish agitation and aggression because non-pharmacological management differs...

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confidence: 99%