Serial Trial Intervention – A Promising Alternative to “Therapeutic Nihilism”

by Anthony Chicotel, CANHR Staff Attorney

I was recently reviewing a couple of studies about the effectiveness of the Serial Trial Intervention (STI) approach to dementia care and was struck by the findings.  In short the STI approach uses physical and affective needs assessments to help identify a targeted intervention any time a person with dementia expresses behavioral challenges.  If those interventions fail, various comfort-focused treatments are attempted and if they don’t work, pain meds are tried.  These four steps are meant to ensure that psychotropic drugs are only considered as a last step – step 5.  As one would expect, care recipient outcomes showed much better improvement in nursing homes that adopted the STI method over those that didn’t.

The authors of the study were careful to point out that most problematic behavior associated with dementia should be considered first and foremost as an expression of unmet need.  Viewed through that perspective, as opposed to a psychiatric perspective, the appropriate treatment is not sedating psychotropic drugs but addressing the need being expressed.  The study’s authors wrote:

“current models of nursing home dementia care constitute a form of therapeutic nihilism in which the severely demented person’s remaining potential for comfort and quality of life is unrecognized or dismissed. Behaviors associated with dementia, viewed as symptoms of unmet needs should be managed not through suppression, but by identifying and meeting the unmet need.”

It appears that STI has been around for nearly a decade, championed by Christine Kovach, a nurse and PhD instructor at the University of Wisconsin-Milwaukee.  As more and more of the dialogue about dementia care shifts away from chemical restraints to non-pharmacologic options, we hope more caregivers will explore STI and adopt its focus on comfort and dignity.

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About achicotel

Anthony Chicotel is a staff attorney for CANHR. His areas of expertise include the rights of long-term care residents, nursing home litigation, health care decision-making, and conservatorships.
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