A Non-Pharmacological Approach to Dementia Care – What Does That Mean?

Are you caring for a loved one with dementia? You don't have to figure this out all on your own. Welcome to Truth, Lies Alzheimer's, the show that helps you reimagine a new relationship with your loved one, a relationship a little more free of stress and anxiety. Join host Lisa Skinner and her 30+ years of experience as she guides you on a new path to a better relationship with those you care for. Here's Lisa.

Hi everyone. Welcome to another brand new episode of The Truth Lies Alzheimer's Show. I'm Lisa Skinner, your host. And today I'm going to be talking about non-pharmacological approaches to dementia care. Which is synonymous with person-centered approach to care, but just from a slightly different angle. So I think it's an important topic to bring up, especially because non-pharmacological approaches to dementia care have actually been proving to be beneficial for many reasons, as supported by research and clinical experience. Now, some of the key factors contributing to the effectiveness of non-pharmacological interventions include individualized and person-centered care. Non-pharmacological interventions are often tailored to the individual's specific needs, preferences, and abilities. And for those of you who aren't quite sure what non-pharmacological approaches to dementia care actually means. It means that we want to create a care plan with using as minimal medications as possible. No medications would probably be ideal, but that is not going to work for every single person's situation. And it's not going to work for every type of brain disease. That causes dementia. For example, frontotemporal dementia. A lot of those folks, because it's really damaging the emotional and communication center of the brain, sometimes need to be slightly medicated to really control those emotional outbursts that happen with that type of dementia. So the person-centered approach recognizes the unique experiences and backgrounds of individuals with dementia, allowing for more targeted and meaningful interventions. So we use that information to create their care plan. It's a holistic approach. Non-pharmacological interventions address the holistic well-being of individuals with dementia. And it encompasses social, emotional, and environmental factors in addition to their cognitive symptoms. So by targeting multiple aspects of a person's life, these interventions can improve overall quality of life as well as their functional abilities. So I'm going to dive a little bit deeper into this topic. Unlike pharmacological treatments, which is using medications, the non-pharmacological interventions generally carry minimal risk of adverse effects, making them particularly suitable for older adults and individuals with multiple medical conditions. This aspect contributes to the safety and tolerability of nonpharmacological approaches. Long-term benefits of nonpharmacological interventions often focus on promoting a sustained lifestyle change and functional abilities, which can have enduring benefits for individuals with dementia. By engaging individuals in meaningful activities and social interactions, as well as cognitive exercises, these interventions may help cognitive function and delay functional decline over the long term. That is a really important consideration. We have shown through studies over decades that the person-centered approach to care versus using medications does help delay a person's decline in their dementia process. It offers support and empowerment to the caregivers. Non-pharmacological interventions often involve training and support for caregivers, empowering them to provide effective care and support for individuals with dementia, and also empowering individuals with dementia to participate in activities that maintain their cognitive function, helps maintain their social engagement, and so importantly, their sense of purpose, thereby promoting their dignity and autonomy. This can lead to improved caregiver well-being and reduced caregiver burden, which in turn can positively impact the well-being of the individuals living with dementia. In terms of the promotion of social interaction, which is a benefit of non-pharmacological approach to dementia care, such as using art therapy, music therapy, group activities, promoting social interaction and meaningful engagement, providing increased purpose and enhanced quality of life. And then the economic considerations. Implementing non-pharmacological approaches obviously may offer potential cost savings by reducing the need for expensive medications and subsequently hospitalizations, and by supporting individuals with dementia to remain in their homes and communities for longer periods. Non-pharmacological approaches may offer potential cost savings by reducing the need for these medications. So promoting empathy and understanding is another benefit that we have found to exist with emphasizing non-pharmacological approaches. It— because it encourages a deeper understanding of the lived experiences of individuals with dementia and also promotes a more empathetic and person-centered approach to care, playing a crucial role in promoting the concept of living well with dementia. It also emphasizes that individuals with dementia can continue to lead meaningful and fulfilling lives despite the challenges they face. This perspective also encourages a more positive and hopeful outlook for individuals with dementia and their families, challenging the prevailing narrative and continuing stigma that dementia is solely a condition of decline and loss. And we all know it is so much more complex than that. As the global population continues to age, The prevalence of dementia is expected to rise. As a matter of fact, it is expected to triple worldwide by the year 2050. Think about that. That's only 11 years away. It's going to be here before we know it. According to the World Health Organization and the Alzheimer's Association, therefore, non-pharmacological approaches become increasingly important. In addressing the growing societal impact of this condition. By investing in non-pharmacological interventions and research, societies can be better prepared to meet the evolving needs of individuals with dementia, as well as promote a more compassionate and inclusive approach to dementia care. By promoting non-pharmacological approaches, we acknowledge the individuality and humanity of each person who is living with dementia, and thereby reinforcing the principle that every individual deserves to be treated with compassion, understanding, and a commitment to preserving their dignity and personhood throughout the progression of the condition. The humanistic approach is fundamental in creating a society that values inclusivity, empathy, and support for individuals with dementia as well as their families. So, how do non-pharmacological approaches to dementia care help people with dementia versus being medicated? Well, it offers several advantages over medication, focusing on enhancing the quality of life and well-being. So, uh, one of the ways is that non-pharmacological approaches prioritize individual preferences, using their histories and their personal wants and needs in the care plan. This personalization fosters a sense of identity and dignity for people living with dementia, making them feel valued and understood, unlike medications that often take a one-size-fits-all approach. The second way it helps reduce the behavioral expressions and symptoms that pop up that we see with people living with dementia. So engaging activities like music therapy, art therapy, and reminiscence therapy can and does effectively reduce anxiety, agitation, and depression, often without the side effects associated with medications. These methods can help individuals express emotions and connect with their surroundings in a meaningful way. Another advantage is through cognitive stimulation. The non-pharmacological strategies often involve cognitive exercises and meaningful engagement that can help maintain cognitive function longer. Through activities that challenge the mind, this can slow the cognitive decline, whereas medications may not provide the same level of engagement or cognitive stimulation. The fourth way is in improved communication and improved relationships. Techniques such as validation therapy, and active listening have proven to improve communication and strengthen relationships. These approaches can create a more supportive and understanding environment, lead to better emotional connections compared to the emotional detachment that can sometimes accompany medication. We've seen fewer side effects Unlike many medications which have, um, proven to show adverse side effects such as sedation, confusion, increased fall risk, non-pharmacological methods typically do not carry these risks. So this leads to a safer care environment enabling individuals to maintain greater independence. And then of course there's the holistic well-being. The non-pharmacological approach is focused on the overall well-being of individuals, addressing their emotional, social, and their psychological needs. This holistic view can lead to improved quality of life as opposed to solely focusing on managing symptoms through medication. That is old school. It offers empowerment and engagement. Activities that involve physical movement, social interaction, and creative expression empower people with dementia to participate in their care and engage with the world around them. Some of us have seen firsthand the catatonic state that a lot of people live in when they are overmedicated living with dementia to try to tame a lot of these behaviors that accompany brain disease. So, as I said, it's in some circumstances they'll have to find a balance of the right dosage of medication. To help tame the behaviors in certain situations. But a lot of people today can be managed effectively and successfully with little to no medication using a person-centered approach to care. This empowerment can boost their self-esteem and promote a sense of agency. For them that medication alone cannot provide. So while medications can be necessary for some individuals, and I can't understate this, non-pharmacological approaches offer a more comprehensive and compassionate way to enhance the lives of people with dementia, focusing on their unique needs and promoting overall well-being. Now, some of the challenges that will arise that I want you to be aware of in a person-centered approach to care is that there will be good days and bad days. So realize that as being part of the challenge. Be patient. Tolerate their behaviors compassionately. Any delays or provocation. Offering reassurance is key. Listen attentively and empathize. Minimize the noise. Noise can disturb and cause confusion in people. Avoid arguing with people who live with Alzheimer's disease and dementia, and do not contradict what they say. You cannot change their belief at that moment. Use nonverbal cues, meaning gestures, touch, facial expressions are powerful communication tools. Be precise. Avoid pronouns such as they, she, or he. Keep it simple. Make sure your questions can be answered with a yes or a no. Be sensitive. Don't talk about them as if they weren't there. Because even in the middle to the latter stages of disease, they are more aware of what's going on in their surroundings than you might give them credit for. And then if you're feeling frustrated, go in another room, take a break. We call this change of face. Either send somebody else in or go away and then come back with a big, huge smile on your face. Some of the information that we collect to create a comprehensive care plan Using the person-centered approach to care include information about their families, their pets, their friends, their past occupation, their spiritual needs, um, what kind of care and support they need, what their likes and dislikes are, and hobbies and interests. And you can actually collect this information that is current and from their life history, because if when they were younger, let's say in the prime of their life, and every morning before they went to work, they took a shower, which is common for a lot of people. Or if you were the person that liked to shower after you got home from work, right before you went to bed, you want to maintain the habits that they are familiar with and comfortable with from that period of their life. Because don't forget, when that short-term memory is malfunctioning, they are going back in their mind to that previous timeframe of their life. And those, that's the routine and the schedule that they're going to be remembering. So if that habit has changed for their showering routine, their showering schedule, and that short-term memory is not working properly, they're going to reflect back on the routine that they maintained in the earlier time of their life. So be mindful of that. I wanted to share a quick story with you from my book, The Truth Lies in Alzheimer's: Its Secret Faces, that really illustrates the power of music therapy, which is part of a person-centered approach to care. And this is absolutely a true story. This really happened. I witnessed it myself. I worked at a facility that started out as just exclusively assisted living. We did not have a memory care wing. When I first started working there, and then we built one. And the, uh, new administrator of the new memory care wing went to assisted living to see if any of the residents who were in assisted living would be more appropriate for the new memory care wing. And she came upon a gentleman who lived in assisted living and his name, I'm going to say, is Sam. That's the name I used in, in the story in the book. So Sam had been in the assisted living wing for several years, and the staff saw him declining rapidly over a several-year period of time, to the point where he wouldn't leave his room. Most of the time he was curled up on his bed in a fetal position. They, um, stopped escorting him to activities and the dining room for meals, and they started bringing him his meals on trays in his room. So they really were almost creating an invalid because they thought what they saw was him declining to the point of almost being completely bedridden. So the administrator of the memory care did an assessment on him and told the administrator of the assisted living wing, Lisa Skinner, that she thought that Sam would be a perfect, perfect candidate for memory care. And they agreed, so they moved him over to the memory care wing. And one day, the staff wheeled Sam out to a music concert that they were holding in the living room of the memory care wing. And I didn't mention that Sam was a Vietnam vet. And he was sitting in his wheelchair and the pianist started playing the song Auld Lang Syne. And this triggered memories for Sam because he was a Vietnam veteran. And she started singing the words to the song Auld Lang Syne, and all of a sudden Sam stood up from his wheelchair and started belting out the words to the song Auld Lang Syne, and everybody was in shock because he just seemed so out of it all the time. Anyway, from that point on, Sam started coming out of himself. Himself more and more and more, to the point where he started talking. I didn't mention that he hadn't talked for over a year. And, uh, he started walking, he started talking, and he went into the administrator's office one day, sat down, and she said to him, Sam, I just am so happy that you're, you're just doing so much better than when you first came here. And he said to her, I really like it here, and I really love the music concerts that are put on here. He said, I look forward to those. And I, I'm not telling you this story because I want to give you the impression or the false hope that person-centered approach to care can make people better and reverse the symptoms because they don't. What we saw with Sam was really a miscalculation of where he was in his illness. They mistook his decline in his interest in life as a decline in the progress of the disease, in the stage of his disease, where really he just kind of became a recluse and climbed inside of himself, probably due to a lot of different reasons. Um, but what music has proven to do, and we've seen it so many times, is trigger memories in people and help them come alive. I remember seeing Tony Bennett on 60 Minutes interview one time, and he, of course, if you weren't aware of it, suffered from Alzheimer's disease. So he went on 60 Minutes and his wife Susan was with them, and she ended up doing all the talking for him during this interview because He obviously did not have a clue who he was or where he was, so Susan was, was answering the questions. Well, they brought his pianist to the show with them, and they motioned the pianist to come start, sit down and play the piano. And I witnessed this firsthand. The pianist started playing some of Tony Bennett's, um, signature songs, and all of a sudden he jumped up from the seat that he was sitting in, walked over to the piano where his pianist was playing his signature songs, and started belting out the words to every song the pianist was playing. He knew every word to every song. This is the magic of music, and I've seen it firsthand. Where before, when he was being interviewed by the, the host, by the interviewer, he was looking around. You could tell through his facial expressions he didn't have a clue where he was, and his wife had to do all the talking for him. But that music triggered those memories and the words to every single song, and it was like magic happened. It was just a remarkable experience. So trust me on this. I have been doing this for 30 years, and I have seen miracles happen to bring the best part of people back out through person-centered approach to care. So hopefully you can start implementing some of these strategies. If you want to learn more about the person-centered approach to care, I have a very detailed training program that is available. You can check it out on www.mindingdementia.com. It's a 6-course training program, and it really goes deep in detail about how to implement a person-centered approach to dementia care into the world and the lives of people living with Alzheimer's disease and dementia. So check that out if you have a mind to. I'll be back next week with another new episode of The Truth, Lies Alzheimer's Show. Once again, I'm Lisa Skinner, your host. I hope you all have a wonderful rest of your week, and it would make me really happy if you all took really good care of yourselves in the meantime. Be back next week. Bye-bye.

Thank you for listening to Truth, Lies Alzheimer's. We hope you found something in today's episode that helps. We understand that caring for a loved one with dementia can be the challenge of a lifetime, but you don't have to do it alone. If you're ready for exclusive access to even more great content and resources, head on over to Facebook and join Lisa Skinner's Minding Dementia support group. We're a community of like-minded caregivers, and we're here to help.