The use of non-pharmacological interventions for dementia behaviours in care homes: findings from four in-depth, ethnographic case studies

Abstract

BackgroundAntipsychotic medications have been used to manage behavioural and psychological symptoms of dementia (BPSD). Due to the potential risks associated with these medications for people with dementia, non-pharmacological interventions have been recommended as safer alternatives. However, it is unknown if, or how, these interventions are used in care homes to help people experiencing BPSD. AimTo explore the use of non-pharmacological interventions in care homes to manage behavioural and psychological symptoms of dementia. MethodsIn-depth, ethnographic case studies were conducted in 4 care homes; in total they included interviews with 40 care-home staff and 384 hours of participant observations. FindingsNon-pharmacological interventions, some of which are the focus of efficacy research, were used in care homes, but predominantly as activities to improve the quality of life of all residents and not identified by staff as meeting individual needs in order to prevent or manage specific behaviours. Socially relevant activities such as offering a cup of tea were used to address behaviours in the moment. Residents with high levels of need experienced barriers to inclusion in the activities. ConclusionsThere is a gap between rhetoric and practice with most non-pharmacological interventions in care homes used as social activities rather than as targeted interventions. If nonpharmacological interventions are to become viable alternatives to antipsychotic medications in care homes further work is needed to embed them into usual care practices and routines. Training for care-home staff could also enable residents with high needs to gain better access to suitable activities.2

Nonpharmacological methods: frequency of use and follow‐up actions among healthcare staff in the care of older people

“…Something that is obviously due to the fact that different professions have different focus in the care around the patient. The use of NPMs has also proved to depend on the context, and NPMs are less common in hospitals than in home care or special housing (8,9,12). This may reflect that ancillary professionals receive more extensive education with respect to implementation of NPM, and therefore integrate these more frequently into their every day care, when compared to nurses, whose focus is often on the hygienic, nutritional and pharmacological care of the patient…”

“…NPMs are generally held to be methods used by nurses and paramedical staff (e.g. nutritionists, physiotherapists and occupational therapists) and among patients themselves, and are often described as self-care or management to promote quality of life, without the use of drugs (7,8). Although NPMs make up part of the foundation in the healthcare organisation, the extent and use of NPMs differ between professionals.…”

“…Although NPMs make up part of the foundation in the healthcare organisation, the extent and use of NPMs differ between professionals. For instance, research has shown (8,9) that nurses and physicians more often used medication than NPMs as treatment, compared with other professionals, and had higher confidence in the effects of drug treatment. Paramedical staff and assistant nurses felt more confidence in NPMs as alternative treatments and thus used NPMs to a higher degree.…”

“…Paramedical staff and assistant nurses felt more confidence in NPMs as alternative treatments and thus used NPMs to a higher degree. The extent of NPM use has been shown to differ between different care settings, with NPMs used more often in nursing homes and ordinary homes than in hospitals (8,9).…”

The Nexus of ‘Music, Mind, and Well-being’: Effects of Harmony in the Bush Music Intervention for Residents with Advanced Dementia in Australian Rural Nursing Homes

“…Pharmacological treatments have been increasingly used in managing behaviours of residents with advanced dementia and promoting their quality of life in residential care (Backhouse et al 2016;White et al, 2017;Olley & Morales, 2018). The pharmacological interventions on behavioural and psychiatric symptoms involves side effects of using antipsychotic medication, such as dizziness and weakness, that result in falls and injuries (Loi et al, 2018;Tan et al, 2018).…”