Reducing distress and medication use in patients with dementia

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FOR OLDER PATIENTS with dementia, few nonpharmacologic interventions are appropriate for treating distressing symptoms such as agitation, restlessness, or decreased mood.1 The medications available are associated with serious adverse reactions, including sedation and increased fall risk, and an increase in mortality.2,3 In 2012, the Centers for Medicare and Medicaid Services and the Pennsylvania Department of Health issued a challenge to long-term-care (LTC) facility administrators to reduce the use of medications for residents with dementia and, concurrently, to improve their quality of life.4,5
This challenge encouraged new ways of thinking about potential interventions, including how medications are helping or hindering those diagnosed with dementia. One novel approach has focused on improving LTC residents' lives through behavioral interventions. The goal is to address residents' needs for relief from distressing symptoms through milieu opportunities instead of administering medications.
This article shares the author's quality and safety-driven project to decrease symptoms of distress in patients with dementia by using valid nonpharmacologic interventions and decreasing medication use.6 The setting is a locked memory unit in an assisted living facility; the 20 residents need consistent monitoring and support for activities of daily living because of memory-related losses. Through education and training of the clinical RNs, LPNs, medication technicians, activity coordinators, and residential aides, collaborative efforts are in progress to improve the quality of life of residents with dementia.

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