by Anthony Chicotel, CANHR Staff Attorney
I recently reviewed the American Medical Directors’ Association’s (AMDA) Clinical Practice Guide to dementia care in nursing homes. The Practice Guide presents a thoughtful, 18-step process for diagnosing and treating dementia in the long-term care setting (psych drugs are not considered until step 12). More importantly, the Guide includes several tips for improving the quality of life of nursing home residents with dementia by focusing on staff training and non-pharmacological interventions.
The Guide recognizes that people with advanced dementia sometimes experience problematic “behaviors” but that they “should be anticipated and accommodated rather than seen as a symptom to be treated.” Symptoms such as anxiety, wandering, and annoying conduct are very amenable to basic behavioral intervention techniques and environmental changes and are particularly poor justifications for drugging since they pose no harm to third parties.
Responsible dementia care requires close observation, thorough and regular documentation, communication and coordination. Nursing home providers should be willing to engage in trial-and-error to resolve behavioral challenges. Recent studies have demonstrated the efficacy of several types of non-drug therapies, environmental changes, and person-centered activities.
I was heartened to see AMDA has adopted such a deliberate method for treating dementia and made it clear that psych drugs are rarely clinically indicated and often dangerous. AMDA agrees that the “medication as a last resort only” approach is best. The problem is that not all practitioners are willing to actually commit to it.